Utilization Review Compliance Analyst - NCQA/URAC (On-site)

Description The Compliance Analyst position is responsible for supporting the Compliance Department in developing, implementing, and administering the continuity of the collective corporate compliance and accreditation programs. This role contributes to key compliance initiatives and organizational objectives. The Compliance Analyst is an essential part of the communication of regulatory and legal compliance within the Utilization Management industry. This role will work in collaboration with all members of the Compliance team, as well as all Nexus and ProPeer business leaders and staff, to develop, implement, and evaluate departmental goals, strategies, programs, and projects that support the continuous improvement process within the Utilization Management and Independent Review arena. The Compliance Analyst acts as an integration and dissemination analyst to transfer knowledge and mobilize key tactics for improvement project activities. This role contributes to the process of developing, executing, driving, and communicating the results of the organization’s Compliance Program for improvement and key collaborative initiatives within budget and assigned deadlines. Requirements Performs and completes audits to meet client, regulatory, and accreditation requirements Assists in the development, drafting, and maintenance of the company’s collective policies, procedures, and best practices documentation Develops audit and monitoring tools for compliance-related activities Analyzes potential risks and areas of non‑compliance to improve organizational practices Monitors developments and changes in federal, state, and local statutes and regulations to assess the impact on the organization and recommends implementation and compliance strategies Tracks applicable licensing, laws, and regulations in the jurisdictions where the organization conducts business, and that might affect the organization’s policies and procedures Maintains current knowledge of accreditation, regulatory compliance, and licensure requirements Understands and is responsible for any regulatory or accreditation reporting requirements Ability to understand, interpret and critically apply regulatory requirements to the organization’s operations by preparing a gap analysis report that will highlight gaps and provide potential solutions Creation, revision, and editing of Compliance policies and procedures under the direction of the Director, Compliance and Senior Vice President, Compliance Responsible for updating, facilitating, and tracking ongoing compliance training and education both internally and externally Provides logistical and operational support for key compliance entities and initiatives (e.g., Quality Management Committee) Provides input for the Compliance Department’s Work Plan and risk assessments Monitors and reports on anonymous feedback regarding the organization’s compliance processes Assists in the administration of the company’s compliance and accreditation programs Promotes adherence to the organization’s Compliance Programs Provides support for ad hoc projects, assignments and other initiatives as needed Experienced in leading committees, activities, and staff Oversees and leads specific projects and project teams as needed Other duties as assigned by the Director, Compliance and Senior Vice President, Compliance Knowledge and Abilities Requirements Knowledge of utilization review processes and managed care Preferred experience with the elements of an effective compliance program, as well as accreditation bodies such as URAC and NCQA Knowledge and experience using continuous improvement/Lean methodologies and processes Ability to work proactively under tight timelines and budgets Ability to coordinate compliance activities involving several departments and processes simultaneously Demonstrated ability to problem‑solve complex, multifaceted situations Ability to maintain a professional manner and function with all levels of management Ability to conduct meetings, compliance training sessions, and other compliance‑related activities Ability to demonstrate strong communication, interpersonal, analytical, writing, presentation, self‑motivation, broad thinking, and business skills Strong organizational and task prioritization skills Strong analytical, numerical, and reasoning abilities Strong attention to detail and a thorough understanding of regulatory requirements Ability to establish credibility and be decisive – but able to recognize and support the organization’s preferences and priorities Project Management experience or ability; awareness of current and emerging trends in project management technologies, techniques, issues, and approaches Competence in both oral and written English Ability to establish and maintain effective and harmonious work relationships with team members, physician panel members, state regulators, clients, and vendors Proficiency using Microsoft Windows, Word, Excel, and PowerPoint Education and Experience Prefer at least 3 years’ experience in the healthcare compliance environment of an accredited organization Previous auditing and/or entity accreditation experience preferred Bachelor’s degree in health information management, health administration, business administration, public administration or related field is preferred License and Certification Willing to obtain various compliance-based certifications within the industry. Position Demands This position requires sitting, bending, and stooping for up to 8 hours per day in an office setting. Ability to lift and move objects weighing up to 10 lbs. Ability to learn technical material. The person in this position occasionally needs to move about inside the office to access filing cabinets, office machinery, etc. Must be able to operate a computer and other office productivity machinery such as a calculator, copy machine, printer, etc. The person in this position frequently communicates with guests, team members, and vendors and must be able to exchange accurate information. Equal Employment Opportunity (Our EEO Statement) The Company is a veteran‑owned Company and provides Equal Employment Opportunities (EEO) to all Team Members and applicants for employment without regard to race, color, religion, sex, sexual orientation, gender (including gender identity), pregnancy, childbirth, or a medical condition related to pregnancy or childbirth, national origin, age, disability, genetic information, status as a covered veteran in accordance with applicable federal, state, and local laws, or any other characteristic or class protected by law and is committed to providing equal employment opportunities. The Company complies with applicable state and local laws governing non‑discrimination in employment. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, promotion, discharge, pay, fringe benefits, membership, job training, classification, and other aspects of employment. Team Members who believe they are the victim of discrimination should immediately report the concern to their Supervisor and the Human Resources Department. Discrimination and harassment will not be tolerated. We are committed to creating an inclusive environment for all Team Members and applicants. We value the unique skills and experiences that veterans bring to our team and encourage veterans to apply. Disclaimer The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of our personnel. All team members may be required to perform duties outside of their normal responsibilities from time to time, as needed. #J-18808-Ljbffr Management Resources Group LLC (MRG)