Compliance Consultant I - Continuing Care (Utilization Review)

Compliance Consultant I - Continuing Care (Utilization Review)

The Compliance Consultant will support the regulatory requirements and internal policies within the health plans specific to utilization review, and compliance functions. This role involves collaborating with various agencies and stakeholders to maintain compliance standards and improve operational efficiency.

They will be assisting with UM components of compliance audits and monitoring activities to identify and mitigate risks.

Job Summary :

This individual contributor is primarily responsible for providing basic support with company compliance activities. Responsibilities include assisting with compliance reporting, compliance investigation, implementation of compliance efforts, and regulatory compliance by acting on updates. This individual contributor also provides support on projects including assisting in development, analysis, and coordination of project plans and coordinating with stakeholders.

Essential Responsibilities :

• Pursues self-development and effective relationships with others by sharing information with coworkers and customers; listening and responding to performance feedback; acknowledging strengths and weaknesses; and adapting to and learning from change, difficulties, and feedback.
• Completes work assignments by following procedures and policies and using data, and resources; collaborating with others to address business problems; adhering to established priorities, deadlines, and expectations; communicating progress and information; occasionally identifying and recommending ways to address improvement opportunities; and escalating issues or risks as appropriate.
• Assists with company compliance activities under the guidance of more senior consultants by providing support to internal and external stakeholders; applying established regulations and standards to compliance efforts; and assisting in the documentation of compliance activities.
• Assists with compliance reporting efforts by monitoring and compiling compliance data and information to identify potential risks and remedies.
• Assists with compliance investigation efforts by collecting data; identifying misalignment with desired compliance actions; assisting with interviews as appropriate.
• Provides support on projects by coordinating stakeholder contacts; assisting in the development, analysis, and coordination of project plans for compliance specific deliverables. and coordinating project schedules and resource forecasts.
• Provides basic support with ensuring regulatory compliance by acting on regulatory updates; and supporting the implementation of designated changes.
• Provides basic support in the implementation of compliance efforts by identifying compliance requirements; supporting the assessment of current state compliance to identify gaps and corrective actions; supporting the creation or revision of basic compliance standards, policies and procedures, and training; and monitoring ongoing compliance adherence.

Minimum Qualifications :

Additional Requirements :

Preferred Qualifications :