Clinical Compliance Consultant Sr

• Job Family: Enterprise Operations
• Req #: JR78810
• Date Posted:Jun 30, 2023
• Type: Full time

Location:

• National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint
• IN, INDIANAPOLIS

Description
Clinical Compliance Consultant Sr
Location: This is a remote work from home opportunity.
The Clinical Compliance Consultant Sr is 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

• Facilitates implementation of survey or regulatory recommendations.
• Assists with the interpretation of applicable laws and regulations.
• Monitors business unit initiatives relating to the development and implementation of a risk management program for utilization management activities.
• Identifies opportunities to manage and mitigate those risks.
• Recommends new processes.
• Monitors development and use of metrics for regulatory compliance.
• 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.
• Creates audit tools, reports, standardized policies and procedures, and manuals.
• Makes recommendations to business unit partners for improvements or remediation to risk management, regulatory, and accreditation compliance programs.
• Compiles information related to quality improvement and compliance monitoring activities for internal use and external audits and maintains relevant records.
• Trains associates on new and revised standards.
• Develops tools that assist in determining exposure to regulatory and/or accreditation 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.
• Collaborates with enterprise quality team, enterprise care management, and other clinical teams on regulatory initiatives.
• 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.

Minimum Requirements
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 Experiences

• Ability to travel to worksite and other locations as necessary, preferred.
• RN preferred.
• Knowledge of clinical regulatory requirements such as experience with CMS and state regulatory and accreditation requirements preferred.

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $66,024 to $132,048.
Locations: California; Colorado; Nevada; Washington State; Jersey City, NJ; New York City, NY; Ithaca, NY and Westchester County, NY
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

• The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the l

Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2022, has been ranked for five years running as one of the 2023 World’s Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact [email protected] for assistance.
EEO is the Law
Equal Opportunity Employer / Disability / Veteran
Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees.

• EEO Policy Statement
• Privacy Notice for California Residents
• Pay Transparency
• Know Your Rights

Elevance Health, Inc. is anE-verify Employer (https://www.e-verify.gov/sites/default/files/everify/posters/EVerifyParticipationPoster.pdf)
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Email us ([email protected]) or call 1-877-204-7664