Legal Advisor, Healthcare Regulatory Compliance

This is a fully remote position, open to applicants in United States.

📋 Description

• Collaborate across departments including Compliance, Legal, Government Affairs, and various business stakeholders.

• Take ownership of EviCore's Medicaid Compliance program and its associated processes.

• Conduct and supervise Medicaid regulatory audits as part of the second line of defense.

• Detect and communicate non-compliance and risk areas to stakeholders for corrective action.

• Analyze data to ensure that preventive measures effectively reduce risk.

• Ensure adherence to state and federal laws and regulations.

• Offer daily Medicaid regulatory guidance to stakeholders.

• Inform stakeholders about updates to Medicaid contracts and regulations.

• Present Medicaid-related issues in regulatory and new law oversight committees.

• Identify trends and risks in Medicaid regulatory compliance through analysis and engagement.

• Participate in client regulatory audits and provide guidance on Medicaid regulations.

• Act as an internal expert on Medicaid matters.

• Advise functional leaders drawing on extensive professional knowledge.

• Provide thought leadership within the Compliance department and contribute to broader business initiatives.

⛳️ Requirements

• A bachelor's degree is required.

• A minimum of 5 years of experience in healthcare compliance, regulatory affairs, utilization management, managed care, or a related field.

• Experience in supporting Medicaid, Commercial, Medicare, or other government-sponsored healthcare programs.

• In-depth knowledge of healthcare regulatory requirements, utilization management regulations, accreditation standards, and compliance best practices.

• Proven experience in interpreting regulations, conducting compliance audits, monitoring activities, performing risk assessments, and overseeing corrective actions.

• Ability to analyze regulatory requirements and provide informed guidance to business, operational, clinical, and legal stakeholders.

• Experience in cross-functional collaboration with Compliance, Legal, Operations, Government Affairs, and business leaders.

• Strong analytical, communication, project management, and problem-solving capabilities.

• Reliable internet connection via a cable broadband or fiber optic service provider with a minimum speed of 10Mbps download and 5Mbps upload for remote work.

• A JD, Master’s degree in a healthcare-related field, Paralegal Certificate, or an active RN license is preferred.

• Clinical RN experience in managed care, utilization management, case management, or health plan operations is preferred.

🏝️ Benefits

• Medical, vision, and dental benefits starting from day one.

• Access to well-being and behavioral health programs.

• 401(k) plan available.

• Company-paid life insurance.

• Tuition reimbursement options.

• A minimum of 18 days of paid time off per year.

• Paid holidays.

• Leaves of absence provisions.

• Eligibility for an annual bonus plan.

• Flexible remote work arrangements.

• Requirement for cable broadband or fiber optic internet for home-based work.