Legal Advisor, Healthcare Regulatory Compliance
About The Position
Working cross-functionally with Compliance, Legal, Government Affairs and business stakeholders, this role will be accountable for EviCore’s Medicaid Compliance program and processes, applicable state and federal regulations, and accreditation requirements. This position performs and oversees Medicaid regulatory compliance second line of defense audits to identify and report on areas of non-compliance and risk, including identifying and analyzing data to ensure that preventative measures are effective in mitigating risk. This position will be responsible for providing Medicaid regulatory and reporting guidance to internal stakeholders and will serve as a Medicaid subject matter expert (SME).
Requirements
- Bachelor's degree required
- 5+ years of healthcare compliance, regulatory affairs, utilization management, managed care, or related healthcare experience.
- Experience supporting Medicaid, Commercial, Medicare, or other government-sponsored healthcare programs.
- Strong knowledge of healthcare regulatory requirements, utilization management regulations, accreditation standards, and compliance best practices.
- Experience interpreting regulations, conducting compliance audits, monitoring activities, risk assessments, and corrective action oversight.
- Ability to analyze regulatory requirements and provide guidance to business, operational, clinical, and legal stakeholders.
- Experience partnering cross-functionally with Compliance, Legal, Operations, Government Affairs, and business leaders.
- Strong analytical, communication, project management, and problem-solving skills.
Nice To Haves
- JD, Master's degree in a healthcare-related field, Paralegal Certificate, or active RN license preferred.
- Clinical experience as an RN within managed care, utilization management, case management, or health plan operations is preferred.
Responsibilities
- Perform and oversee second line of defense Medicaid regulatory audits to identify regulatory and compliance risks and report findings to stakeholders for remediation.
- Ensure compliance with state and federal laws and regulations
- Provide day-to-day Medicaid regulatory guidance to stakeholders
- Provide necessary notification to stakeholders on updated Medicaid contracts and regulations
- Key Medicaid presenter in EviCore’s regulatory and new law oversight committees
- Identify Medicaid regulatory compliance trends and risk to the company through analysis and engagement
- Participate in client regulatory audits to observe and provide Medicaid regulatory guidance
- Recognized internally as a subject matter expert
- Use deep professional knowledge and acumen to advise functional leaders
- Focus on providing thought leadership within Compliance but work on broader projects, which require understanding of the wider business
Benefits
- medical
- vision
- dental
- well-being and behavioral health programs
- 401(k)
- company paid life insurance
- tuition reimbursement
- a minimum of 18 days of paid time off per year
- paid holidays
- leaves of absence
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What This Job Offers
Job Type
Full-time
Career Level
Senior
