Compliance Consultant I - Continuing Care (Utilization Review)

Kaiser Permanente • Atlanta, GA

109d

About The Position

The Compliance Consultant will support the regulatory requirements and internal policies within the health plans specific to utilization review, and compliance functions. This role involves collaborating with various agencies and stakeholders to maintain compliance standards and improve operational efficiency. They will be assisting with UM components of compliance audits and monitoring activities to identify and mitigate risks. This individual contributor is primarily responsible for providing basic support with company compliance activities.

Requirements

• Associates degree or a minimum sixty (60) credits towards a Bachelor's degree in Health Care Administration, Clinical, Law, Public Health, Business or related field OR Minimum one (1) year experience in compliance, health care operations (quality, risk, etc.), audit, finance, project management, regulatory or public policy development, investigations, information security, or insurance/health plan governance or a directly related field.

Responsibilities

• Assisting with compliance reporting, compliance investigation, implementation of compliance efforts, and regulatory compliance by acting on updates.
• Providing support on projects including assisting in development, analysis, and coordination of project plans and coordinating with stakeholders.
• Pursuing self-development and effective relationships with others by sharing information with coworkers and customers; listening and responding to performance feedback; acknowledging strengths and weaknesses; and adapting to and learning from change, difficulties, and feedback.
• Completing work assignments by following procedures and policies and using data, and resources; collaborating with others to address business problems; adhering to established priorities, deadlines, and expectations; communicating progress and information; occasionally identifying and recommending ways to address improvement opportunities; and escalating issues or risks as appropriate.
• Assisting with company compliance activities under the guidance of more senior consultants by providing support to internal and external stakeholders; applying established regulations and standards to compliance efforts; and assisting in the documentation of compliance activities.
• Assisting with compliance reporting efforts by monitoring and compiling compliance data and information to identify potential risks and remedies.
• Assisting with compliance investigation efforts by collecting data; identifying misalignment with desired compliance actions; assisting with interviews as appropriate.
• Providing support on projects by coordinating stakeholder contacts; assisting in the development, analysis, and coordination of project plans for compliance specific deliverables; and coordinating project schedules and resource forecasts.
• Providing basic support with ensuring regulatory compliance by acting on regulatory updates; and supporting the implementation of designated changes.
• Providing basic support in the implementation of compliance efforts by identifying compliance requirements; supporting the assessment of current state compliance to identify gaps and corrective actions; supporting the creation or revision of basic compliance standards, policies and procedures, and training; and monitoring ongoing compliance adherence.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Ambulatory Health Care Services
• Education Level: Associate degree