WARNING: Please beware of phishing scams that solicit interviews or promote work-at-home opportunities, some of which may pose as legitimate companies. Elevance Health requires a completed online application for consideration of employment for any position. We will never ask you for a credit card, send you a check, or ask you for payment as part of consideration for employment.

　　Oversight Compliance Consultant Sr

　　Job Family: Medical and Clinical

　　Type: Full time

　　Date Posted:Jan 23, 2024

　　Anticipated End Date:Feb 02, 2024

　　Reference: JR102448

　　Location:

　　Georgia, Atlanta

　　Florida, Tampa

　　Indiana, Indianapolis

　　Description

　　Oversight Compliance Consultant Sr (JR102448)

　　Location: Must reside within 50 miles (1 hour commute) to Elevance Health main office. This position is part of our Hybrid worksite strategy and requires 1-2 days per week in the local office.

　　The Oversight Compliance Consultant Sr is responsible for serving as point of contact, coordinating and collaborating primarily with delegated entities and internal health plan functional units to ensure compliance with regulatory, accrediting and health plan quality of care and service requirements. Promotes and maintains favorable working partnerships and relationships with delegated entities, physicians, healthcare service providers, and internal customers to improve delivery and quality of health care. Primary duties may include, but are not limited to:

　　Performs annual and ad hoc delegation oversight audits and internal health plan functional unit audits.

　　Develops corrective action plans and analyses of required program reports and internal performance measures.

　　Acts as an operational expert and interventionist through communication, education, and design of programs and strategies to assist delegated entities and internal departments meet regulatory and accrediting standards, promote quality outcomes, and maximize resources.

　　Develops training materials and conducts training and/or new hire orientation.

　　Delivers timely and constructive coaching and feedback.

　　Assists with planning and implementation of formal education sessions to external customers to address non-compliance issues.

　　Takes lead with healthcare industry collaborations so as to enhance regulatory and accrediting compliance among constituents.

　　Ensures that all policies and procedures are updated as legislation or accreditation standards change.

　　Assists with standardization of procedures and documentation.

　　Assists in problem-solving with delegated entities and internal constituents.

　　Minimum Requirements:

　　AS in nursing and minimum of 5 years of acute care, utilization management, quality management in a hospital and/or HM setting and minimum of 2 years of experience conducting oversight audits of delegated entities and/or ancillary providers; or any combination of education and experience, which would provide an equivalent background.

　　Current unrestricted RN license or LCSW in state of residence required.

　　Preferred Qualifications:

　　Strong knowledge of managed care principles and delivery systems, the medical management process, accreditation and regulatory standards, delegated oversight processes, and workflow systems strongly preferred.

　　Familiar with medical policy, URAC, NCQA, etc.

　　Experience with Medicaid, Commercial, and Medicare a plus.

　　Proficient using MS Word, Excel, PowerPoint, Teams and/or WebEx.

　　ACMP a plus.

　　Experience with Audits and Provider education.

　　BS in nursing preferred.

　　May Travel to worksite and other locations as necessary.

　　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.

　　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

　　Know Your Rights

　　Pay Transparency

　　Privacy Notice for California Residents

　　Elevance Health, Inc. is anE-verify Employer (https://www.e-verify.gov/sites/default/files/everify/posters/EVerifyParticipationPoster.pdf)

　　Need Assistance?

　　Email us ([email protected])