Legal Compliance Advisor

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).

KEY DUTIES AND 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

QUALIFICATIONS

• Bachelor's degree required; JD, Master's degree in a healthcare-related field, Paralegal Certificate, or active RN license preferred.
• 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.
• Clinical experience as an RN within managed care, utilization management, case management, or health plan operations is preferred.
• Strong analytical, communication, project management, and problem-solving skills.

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an annual salary of 96,200 - 160,400 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence. For more details on our employee benefits programs, click here.

About Evernorth Health Services

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you need a reasonable accommodation to complete the online application process, please email [email protected] for assistance.  Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.