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In-House
Attorney
Health Care
Min 5 yrs required
Divisional Compliance Consultant The candidate: Manages or coordinates departmental/divisional activities to ensure compliance with new and existing laws, regulations and requirements. Identifies compliance risks and works with Corporate Compliance and other business areas as needed to develop and/or facilitate implementation of corrective action plans to mitigate risks. Conducts audits and compliance reviews to monitor ongoing compliance. Ensure departmental/divisional compliance with existing laws, regulations and requirements by leading and supporting cross functional activities that may impact a range of critical business processes aligned directly to key strategic initiatives. Collaborates closely with division team members, business owners, sponsors, and partners in the analysis, design, development, implementation, and operational support of system/process enhancements and configurations to ensure quality, cost effectiveness, timeliness of customer service, and regulatory requirements and mandates are met. Conduct risk assessments and/or audits and monitor department/divisional systems for compliance. Ensure appropriate implementation and/or corrective action is taken to address risks and issues identified in partnership with Corporate Compliance. Research, investigate, and evaluate departmental environment and recommend remediation initiatives and/or compliance programming in consultation with Corporate Compliance. Perform review of operational policies for compliance with state/federal laws and regulations and/or process improvements/efficiencies as needed. Ensures that necessary controls are in place to monitor the effects of new functionality, and communicates status and changes to affected parties. Manage and/or facilitate departmental/divisional implementation and remediation of compliance initiatives in conjunction with Corporate Compliance. Develop and implement training and other communications for department personnel as needed. May serve as privacy coordinator for CRPI, first point of contact and provide subject matter expertise for privacy related questions. Develop and implement corrective action plans to address identified privacy issues. Must have Bachelor’s Degree and 5+ years of work experience in health insurance, health care, compliance or regulatory affairs that provides the candidate with strong knowledge of health care regulations and products. Project management skills are required. Some experience in consultative/advisory role is preferred. RN with NC license preferred. Certified Professional Coder preferred.
Ref: RQ0002286
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