Compliance Manager
Elevance Health

Job Info

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Compliance Manager

Location: This position will work a hybrid model (remote and office). The Ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.

The Compliance Manager will be responsible for managing foundational and strategic compliance responsibilities with consistent excellence that support the team and management. The Compliance Manager is part of the Medicaid Compliance Business Development Team and oversees Medicaid Implementations by supporting state-mandated readiness reviews. This position acts as the implementation lead and are the liaisons for our State Agencies during the implementation. They serve as interim Medicaid Compliance Officers/Contract Managers until Go Live where the responsibilities are then transitioned to the Plan Compliance Officer and Health Plan.

How you will make an impact:

• Collaborate with business partners on interpreting readiness review requirements; universe audits; reporting submissions; and State regulator interface and communications. This includes facilitating meetings and leading on site readiness reviews.
• Work closely with the Government Business Execution Team and Medicaid Plan Compliance Officers in varying markets.
• Manage/oversee projects, initiatives, regulatory audits or exams, internal audits, accreditations, on-site reviews, risk assessments; audit planning, conducting mock audits, conducting audit training, managing audit evidence preparation, assessing audit preparedness.
• Establish project plans, gap analysis, milestone dates, and other significant aspects, and leadership updates.
• Maintain knowledge of laws, regulations, company strategies to assess impact, and consult with clients as subject matter expert.
• Conducts complex investigations, document findings, and ensure corrective actions are made.
• Interface with external clients, regulators, vendors, supplier; internal stakeholders, high level of management.
• Travels to worksite and other locations as necessary.

Minimum Requirements:

Requires a BA/BS and minimum of 6 years health care, regulatory, ethics, compliance or privacy experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

• MS/MBA/JD or professional designation preferred.
• Prior project management experience preferred.
• Experience with SharePoint and Excel highly preferred.
• Familiarity with JIRA preferred.

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