Description
SHIFT: Day Job
SCHEDULE: Full-time
Your Talent. Our Vision. At CareMore, a proud member of the Anthem, Inc. family of companies, it’s a powerful combination. It’s the foundation upon which we’re creating greater access to care for our members, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care.
CareMore is a proven care delivery model for the highest-risk. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery. We build and lead integrated, multi-disciplinary clinical teams to care for the most complex patients. We strive for excellence and have achieved significant and measurable improvement in total cost of care, clinical outcomes, and experience. As an Anthem subsidiary, we benefit from the scale and resources one of America’s largest managed healthcare organizations.
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. 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. Leads department projects, and mentors clinical compliance staff.
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. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.
Qualifications
Requires a BA/BS and minimum of 5 years experience, including a minimum of 3 years regulatory, compliance or accreditation, and auditing experience; or any combination of education and experience, which would provide an equivalent background.
RN preferred.
Ability to travel may be required.
Knowledge of clinical regulatory requirements, such as those of state regulatory agencies, accreditations, and CMS strongly preferred.
Position is eligible for REMOTE Work from Home.
REQNUMBER: PS56485
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