Compliance Manager - Louisiana Plan Compliance Officer

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Compliance Manager- Plan Compliance Officer

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.

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 includes 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.
• MS / MBA or professional designation preferred.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health.

Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Elevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates.

Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient / member-facing roles to become vaccinated against COVID-19.

If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.

Applicants who require accommodation to participate in the job application process may contact [email protected] for assistance.

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