Clinical Compliance Director (Medical, Behavioral Health, or Pharmacy)
DescriptionSHIFT: Day Job
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 Director is responsible for supporting clinical regulatory compliance for lines of businesses or a region.
Primary duties may include, but are not limited to:
- Leads the coordination and collaboration to ensure compliance with regulatory, accrediting, and Health Plan quality of care and service requirements.
- Oversees the development of tools that assist in determining exposure to regulatory and accreditation risks and identifies opportunities to manage and mitigate those risks.
- Collaborates with teams and business management areas to develop metrics for monitoring program objectives, policies, and procedures that support regulatory and accreditation standards compliance.
- Collects and maintains information related to quality improvement and compliance monitoring activities.
- Recommends improvements or remediation to risk management, regulatory, and accreditation compliance programs.
- Supports quality committee activities.
- Leads department projects and serves as a subject matter expert.
- Requires a BA/BS in health administration or a related field and minimum of 8 years of experience, including minimum of 4 years regulatory, compliance or accreditation, and auditing experience; or any combination of education and experience, which would provide an equivalent background.
- Ability to travel may be required.
- Experience with Pharmacy, Medical, and Behavioral Health experience preferred.
- Claims processing or claims operations experience preferred.
- Knowledge of clinical regulatory requirements, state regulatory agencies and accrediting bodies strongly preferred.
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 Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.
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 careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact [email protected] for assistance.
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.