Location: Must be located in/a resident of Louisiana.
This position will take part in Elevance Health's hybrid workforce strategy which includes virtual work and 1-2 days in office per week, with the in office setting in Metairie, LA.
The Compliance Manager/Plan Compliance Officer is an individual contributor that owns facilitation of the relationship with the state of Louisiana, Louisiana Department of Health. This include working closely with the Compliance Director around issue remediation and understanding of the root causes and control breakdowns that lead to member, provider, and state complaints/issues. This role works directly with local plan leadership, and ensures key interactions with the Louisiana Department of Health are appropriately addressed.
How You Will Make an Impact
Primary duties with advanced complexity and broad/enterprise scale may include, but are not limited to:
Tracker of issue remediation, confirming our business partners understand and address the root cause and control breakdowns that lead to member, provider, and state complaints/issues.
Reviewing state defined quality metrics performance, vendor and affiliate monitoring and audit performance.
Oversee health plan implementation of new local and enterprise-wide initiatives.
Researches and responds to questions about requirements in the contract, and state-based interpretation and enforcement of those requirements and owns the Louisiana Medicaid Compliance Committee.
Supports business development and maintenance of the contract through request for proposal support. Supports health plan leaders with business operational reviews with senior Medicaid leadership.
Meets with the key regulatory contacts biweekly or more often as needed, ensuring the health plan is meeting regulatory expectations.
Supports Elevance's Audit COE in understanding the state requirements that are being audited against, and the key state health plan leaders (local and centralized) responsible for each area of the audit.
Review collateral and member messaging developed that would be distributed to members for the state (local, compliance related, and centralized).
Performs reviews of policies and procedures developed locally, and for centralized support to ensure compliance with state contracts.
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.
Minimum of 3 years' leadership experience.
Preferred Skills, Capabilities, and Experiences:
Managed care operations experience highly preferred.
Strong leadership/managerial skills and ability to motivate/coach other staff strongly preferred.
