Anticipated End Date:

2024-12-31

Position Title:

Clinical Compliance Manager

Job Description:

Title: Clinical Compliance Manager

 

Location: Candidates must reside within 50 miles of one of our Kansas Pulse Points

 

Build the Possibilities. Make an Extraordinary Impact.

The Clinical Compliance Manager is responsible for supporting clinical regulatory compliance for lines of business enterprise wide or complex state, delegated entities and/or subsidiaries through project leadership, technical oversight and risk identification and mitigation.

How you will make an impact:

Primary duties may include, but are not limited to:

• Serves as the 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.

• Develops tools that assist in determining exposure to regulatory and 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.

• Compiles information related to quality improvement and compliance monitoring activities, and maintains relevant records.

• Provides guidance and oversight to business unit audit functions to ensure ongoing regulatory and accreditation compliance, and monitors corrective action plans relating to regulatory and accreditation compliance.

• Makes recommendations to business unit partners for improvements or remediation to risk management, regulatory, and accreditation compliance programs.

• Monitors development and use of metrics for regulatory and accreditation compliance.

• Monitors business unit initiatives relating to the development and implementation of a risk management program for utilization management activities.

• Collaborates with enterprise quality teams, enterprise care management teams, and other clinical departments on regulatory initiatives.

• Supports quality committee activities.

• Travels to worksite and other locations as necessary.

  

Minimum Requirements:

• Requires a BA/BS and minimum of 5 years experience, including minimum of 3 years regulatory, compliance or accreditation, and auditing experience; or any combination of education and experience, which would provide an equivalent background.

 

Preferred Skills, Capabilities and Experiences:

• RN preferred.

• Knowledge of clinical regulatory requirements, such as those of state regulatory agencies, accreditations, and CMS strongly preferred.

Job Level:

Non-Management Exempt

Workshift:

Job Family:

FRD > Compliance

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

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.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

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 an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

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.