Clinical Compliance Manager at Elevance Health

Washington, District of Columbia, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

BA/BS degree and minimum of 5 years of experience, including minimum of 3 years in regulatory, compliance or accreditation, and auditing experience (or equivalent combination of education and experience)
Ability to work in-office 4 days per week in Washington, DC (or alternate locations; candidates not within reasonable commuting distance not considered unless accommodation granted)
Willingness to travel to worksite and other locations as necessary

Responsibilities

Serve 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
Develop tools to determine exposure to regulatory and accreditation risks and identify opportunities to manage and mitigate those risks
Work with business management areas to develop metrics for monitoring program objectives and policies/procedures supporting compliance with regulatory and accreditation standards
Compile information related to quality improvement and compliance monitoring activities, and maintain relevant records
Provide guidance and oversight to business unit audit functions to ensure ongoing regulatory and accreditation compliance, and monitor corrective action plans
Make recommendations to business unit partners for improvements or remediation to risk management, regulatory, and accreditation compliance programs
Monitor development and use of metrics for regulatory and accreditation compliance
Monitor business unit initiatives relating to the development and implementation of a risk management program for utilization management activities
Collaborate with enterprise quality teams, enterprise care management teams, and other clinical departments on regulatory initiatives
Support quality committee activities, lead department projects, and mentor clinical compliance staff
Support 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

Skills

Regulatory Compliance

Clinical Compliance

Risk Management

Project Leadership

Audit Oversight

Quality Improvement

Metrics Development

Policy Development

Corrective Action Plans

Accreditation Standards

Elevance Health

Integrated health services and digital platform

About Elevance Health

Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.

Indianapolis, IndianaHeadquarters

1944Year Founded

$309.4MTotal Funding

IPOCompany Stage

Enterprise Software, Social Impact, HealthcareIndustries

10,001+Employees

Benefits

Medical, dental, & vision insurance

401(k) + match

Paid holidays

Paid Time Off

Incentive bonus programs

Stock purchase plan

Life insurance

Wellness Programs

Financial education resources

Adoption & Surrogacy Assistance

Dependent-care Flexible Spending Account (DCFSA)

Parental Leave

Parental Transition Week

Critical Caregiving Leave

Risks

Departure of CFO John Gallina may create a gap in financial leadership.

Lawsuit against CMS over MA Star Ratings could lead to financial penalties.

CareBridge integration may face operational challenges, disrupting service delivery.

Differentiation

Elevance Health integrates whole health approach with digital health platform for comprehensive care.

Acquisition of CareBridge enhances home health services within Carelon division.

Strategic partnership with Clayton, Dubilier & Rice aims to innovate primary care delivery.

Upsides

AI integration in home health services can reduce hospital readmissions and improve outcomes.

Predictive analytics support early disease detection, aligning with Elevance's whole health approach.

Telehealth expansion offers opportunities to reach more patients remotely.

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