Oversight Compliance Consultant Senior
Company: The Elevance Health Companies, Inc.
Location: Cypress
Posted on: January 23, 2023
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Job Description:
Position Title:Oversight Compliance Consultant SeniorJob
Description: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.Please Note: This is a Remote
role How you will make an impact:--- - - -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.Qualifications:--- - - -Requires 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 applicable
state(s) required. ---- - - -Travel may be required.Preferred
Skills, Capabilities and Experiences:--- - - -Knowledge of managed
care principles and delivery systems, the medical management
process, accreditation and regulatory standards, delegated
oversight processes, and workflow systems ---- - - -BS in nursing
---- - - -Prior/Current Pharmacy experienceJob Level:Non-Management
ExemptWorkshift:1st Shift (United States of America)Job Family:MED
> Licensed/Certified - OtherWe 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 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 2021, is ranked as one of the 2021 World's Most Admired
Companies among health insurers by Fortune magazine, and a Top 20
Fortune 500 Companies on Diversity and Inclusion. To learn more
about our company and apply, please visit us at . 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 contactfor assistance.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 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 2021, is ranked as one of the 2021 World's Most Admired
Companies among health insurers by Fortune magazine, and a Top 20
Fortune 500 Companies on Diversity and Inclusion. To learn more
about our company and apply, please visit us at. 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 for assistance.
Keywords: The Elevance Health Companies, Inc., Cypress , Oversight Compliance Consultant Senior, Professions , Cypress, California
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