Clinical Compliance Consultant

at Anthem, Inc in Wilmington, Delaware, United States

Job Description


SHIFT: Day Job

SCHEDULE: Full-time

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 The Clinical Compliance Consultant is responsible for the support of the clinical regulatory compliance for state, delegated entities, or enterprise-wide designated lines of business through project leadership, technical oversight, and risk identification and mitigation. Primary duties may include, but are not limited to:

+ Serves as 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.

+ Assists with the interpretation of applicable laws and regulations.

+ Develops tools that assist in determining exposure to regulatory and/or 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.

+ Compile’s information related to quality improvement and compliance monitoring activities for internal use and external audits and maintains relevant records.

+ Monitors corrective action plans relating to regulatory or accreditation compliance.

+ Makes recommendations to business unit partners for improvements or remediation to risk management, regulatory, and accreditation compliance programs.

+ Monitor’s development and use of metrics for regulatory compliance.

+ Monitor business unit initiatives relating to the development and implementation of a risk management program for utilization management activities.

+ Collaborates with enterprise-quality team, enterprise care management, and other clinical teams on regulatory initiatives.

+ Creates audit tools, reports, standardized policies and procedures, and manuals.

+ Facilitates implementation of survey or regulatory recommendations.

+ Recommends new processes.

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. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at 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.


Minimum Requirements:

+ BA/BS and minimum of 3 years professional experience, including a minimum of 1 year quality, regulatory, compliance, accreditation, and/or auditing experience; or any combination of education and experience, which would provide an equivalent background.

+ Ability to travel may be required.

Preferred Requirements:

+ RN preferred

+ Knowledge of clinical regulatory requirements such as experience with CMS and state regulatory and accreditation requirements is preferred.

Applicable to Colorado Applicants Only Annual Salary Range*: $72,300 – $86,760 Actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level.
  • The hourly or salary range is the range Anthem in good faith believes is the range of possible compensation for this role at the time of this posting. The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and
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Job Posting: JC193166859

Posted On: Sep 24, 2021

Updated On: Oct 20, 2021