Elevance Health Clin Compliance Consult Sr in Winston Salem, North Carolina
Clin Compliance Consult Sr
Job Family: Enterprise Operations
Type: Full time
Date Posted:Aug 02, 2022
Req #: JR11748
North Carolina, North Carolina
South Carolina, South Carolina
Responsible for supporting clinical regulatory compliance for a state, delegated entities, or enterprise wide for designated lines of business through project leadership, technical oversight and risk identification and mitigation.
How you will make an impact:
Serves as point of contact, coordinating and collaborating with regulatory bodies and business partners to ensure compliance with regulatory, accrediting, and Health Plan quality of care and service requirements.
Assists with the interpretation of applicable laws and regulations.
Develops tools that assist in determining exposure to regulatory and/or accreditation risks.
Identifies opportunities to manage and mitigate those risks.
Works with business management areas to develop metrics for monitoring program objectives and policies and procedures that support compliance with regulatory and accreditation standards.
Compile information related to quality improvement and compliance monitoring activities for internal use and external audits and maintains relevant records.
Provides guidance and oversight to business units to ensure ongoing regulatory or accreditation compliance and monitors corrective action plans relating to regulatory or accreditation compliance.
Makes recommendations to business unit partners for improvements or remediation to risk management, regulatory, and accreditation compliance programs.
Monitor’s development and use of metrics for regulatory compliance.
Monitor business unit initiatives relating to the development and implementation of a risk management program for utilization management activities.
Collaborates with enterprise quality team, enterprise care management, and other clinical teams on regulatory initiatives.
Creates audit tools, reports, standardized policies and procedures, and manuals.
Facilitates implementation of survey or regulatory recommendations.
Recommends new processes.
Trains associates on new and revised standards.
- Requires a BA/BS and minimum of 5 years professional experience, including minimum 3 years regulatory, compliance, accreditation, and/or auditing experience; or any combination of education and experience, which would provide an equivalent background..
Preferred Skills, Capabilities, and Experience:
Ability to travel may be required.
Knowledge of clinical regulatory requirements such as experience with CMS and state regulatory and accreditation requirements preferred.
Credentialing experience preferred
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