Compliance Director - Medicaid

Elevance Health•Cincinnati, OH

4d•Hybrid

About The Position

The Compliance Director - Medicaid is responsible for directing foundational and strategic compliance responsibilities with consistent excellence that support the team and management. This role requires associates to be in-office(Ohio based) 1-2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Candidates not within a reasonable commuting distance from the posting location will not be considered for employment, unless an accommodation is granted as required by law. This position is not eligible for current or future VISA sponsorship.

Requirements

Requires a BA/BS and minimum of 8 years health care, regulatory, ethics, compliance or privacy experience; or any combination of education and experience, which would provide an equivalent background.

Nice To Haves

Experience with Medicaid Managed Care preferred
Experience working with regulators such as the Ohio department of Medicaid preferred
Experience with Medicaid contract interpretation preferred
Strong leadership/managerial skills and ability to motivate/coach other staff strongly preferred.
Travels to worksite and other locations as necessary.
MS/MBA/JD or professional designation preferred.

Responsibilities

Directs projects, initiatives, regulatory sanctions, executive-sponsored initiatives, regulatory audits or exams, internal audits, accreditations, on-site reviews, risk assessments; audit planning, conducting mock audits, conducting audit training, managing audit evidence preparation, assessing audit preparedness.
Leads compliance monitoring to identify process gaps, validate compliance levels, map processes, draft corrective actions/remediation plans, oversee implementation of corrective actions, prepare reports/presentations.
Leads complex investigations and documents findings.
Develops strategic plans, makes recommendations to leadership; designs/implements annual compliance plan.
Develop strong relationships with key leaders to identify and address compliance risks and failures and manage action plans designed to fully mitigate risk(s).