Oversight Compliance Consultant Senior- Any Anthem Location in CA

Company: Anthem, Inc.
Location: Sacramento
Posted on: April 8, 2021

Job Description:

Welcome to the Anthem Careers site! We have been hard at work to improve our job search and application systems to better serve you. It is now easier to find and apply for relevant jobs as well as stay connected with Anthem. Here are a few of the updates you may notice:

• No more profiles! We no longer require you to create a log in and password to apply for a job and you won't be able to access previously created profiles, but don't worry - we still have your previous application(s) on file and you can still track your status by clicking on the "Track Your Job Application Status" button.
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• NEW! Didn't find a job that is right for you? Join a Talent Network to stay informed on news and job opportunities with the Anthem Team! It is important that you apply using an email address which is unique to you and not shared with a friend, relative, spouse, or significant other. Our recruiting system uses your email address as your unique identifier. If you apply with a shared email address, your application will overwrite any previous applicant record with the same email address. Additionally, please ensure that you use a valid email address, free from typos, as there are a variety of communications which may be sent to the email address with which you apply Oversight Compliance Consultant Senior- Any Anthem Location in CA Your Talent. Our Vision. At Anthem, Inc., it's a powerful combination, and the foundation upon which we're creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.-- This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health care companies and a Fortune Top 50 Company. Location: Any California Anthem Core Office Location, Woodland Hills, CA preferred (once offices reopen)
  Hours are core business hours Responsible for serving as point of contact, coordinating and collaborating primarily with delegated entities and internal health plan functional units to ensure compliance with regulatory, accrediting and health plan quality of care and service requirements. Promotes and maintains favorable working partnerships and relationships with delegated entities, physicians, healthcare service providers, and internal customers to improve delivery and quality of health care. Primary duties may include, but are not limited to:
  • Performs annual and ad hoc delegation oversight audits and internal health plan functional unit audits.
  • Develops corrective action plans and analyses of required program reports and internal performance measures.
  • Acts as an operational expert and interventionist through communication, education, and design of programs and strategies to assist delegated entities and internal departments meet regulatory and accrediting standards, promote quality outcomes, and maximize resources. Develops training materials and conducts training and/or new hire orientation.
  • Delivers timely and constructive coaching and feedback.
  • Assists with planning and implementation of formal education sessions to external customers to address non-compliance issues.
  • Takes lead with healthcare industry collaborations so as to enhance regulatory and accrediting compliance among constituents.
  • Ensures that all policies and procedures are updated as legislation or accreditation standards change.
  • Assists with standardization of procedures and documentation.
  • Assists in problem-solving with delegated entities and internal constituents. Qualifications Requires an AS/BS in nursing; 5 years of--utilization management, regulatory, compliance, accreditation, quality management and/ or auditing experience in a hospital and/or managed care setting or any combination of education and experience, which would provide an equivilant background,-- 2 years of experience conducting oversight audits of delegated entities and/or ancillary providers; or any combination of education and experience, which would provide an equivalent background, preferred. Must have strong knowledge of managed care principles and delivery systems, the medical management process, accreditation and regulatory standards, delegated oversight processes, and workflow systems. May require some travel.
    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.
    
    An Equal Opportunity Employer/Disability/Veteran Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions. Please be advised that Anthem only accepts resumes from agencies that have a signed agreement with Anthem. Accordingly, Anthem is not obligated to pay referral fees to any agency that is not a party to an agreement with Anthem. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Anthem. EEO is the Law Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees. Anthem, Inc. is committed to helping individuals with disabilities participate in the workforce and ensuring equal opportunity to apply and compete for jobs. If you are an individual with a disability and require a reasonable accommodation to complete the application process, please email Human Resources at ability@icareerhelp.com for further assistance. *WARNING : Please beware of phishing scams that solicit interviews or promote work-at-home opportunities, some of which may pose as legitimate companies. Please be advised that Anthem will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission here by selecting the 'Rip-offs and Imposter Scams' option. Anthem requires a completed online application for consideration of employment for any position.

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