Anthem Clinical Compliance Manager, RN PS1080 in Birmingham, Alabama

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 benefits companies and a Fortune Top 50 Company.

Responsible for supporting clinical regulatory compliance for lines of business enterprise wide or complex state, delegated entities and/or subsidiaries through project leadership, technical oversight and risk identification and mitigation. Primary duties may include, but are not limited to: Serves as the point of contact, coordinating and collaborating with regulatory bodies and business partners to ensure compliance with regulatory, accrediting and Health Plan quality of care and service requirements. Develops tools that assist in determining exposure to regulatory and accreditation risks. Identifies opportunities to manage and mitigate those risks. Works with business management areas to develop metrics for monitoring program objectives and policies and procedures that support compliance with regulatory and accreditation standards. Compiles information related to quality improvement and compliance monitoring activities, and maintains relevant records. Provides guidance and oversight to business unit audit functions to ensure ongoing regulatory and accreditation compliance, and monitors corrective action plans relating to regulatory and accreditation compliance. Makes recommendations to business unit partners for improvements or remediation to risk management, regulatory, and accreditation compliance programs. Monitors development and use of metrics for regulatory and accreditation compliance. Monitors business unit initiatives relating to the development and implementation of a risk management program for utilization management activities. Collaborates with enterprise quality teams, enterprise care management teams, and other clinical departments on regulatory initiatives. Supports quality committee activities. Leads department projects, and mentors clinical compliance staff.

Requires a BS/BA; 5 years of experience including 3 years of regulatory, compliance or accreditation, and auditing experience; or any combination of education and experience, which would provide an equivalent background. RN strongly preferred. Ability to travel may be required. Knowledge of clinical regulatory requirements, such as those of state regulatory agencies, accreditations, and CMS required.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2016 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at EOE. M/F/Disability/Veteran.

Job Medical

Equal Employment Opportunity Statement Anthem, Inc. will recruit, hire, train and promote persons in all job titles without regard to age, color, disability, gender (including gender identity), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other status protected by applicable law. In addition, all personnel actions such as compensation, promotion, demotion, benefits, transfers, staff reductions, terminations, reinstatement and rehire, company-sponsored training, education and tuition assistance, and social and recreational programs will be administered in accordance with the principles of equal employment opportunity.

Title: Clinical Compliance Manager, RN PS1080

Location: Alabama-Birmingham

Requisition ID: PS1080