Compliance Manager - Louisiana Plan Compliance Officer

Compliance Manager- Plan Compliance Officer Location: This role requires associates to be in-office 1 - 2 days per week at our Metairie, LA location, fostering collaboration and connectivity while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law. The Compliance Manager/Plan Compliance Officer is an individual contributor that owns facilitation of the relationship with the state of Louisiana, Louisiana Department of Health. This includes working closely with the Compliance Director around issue remediation and understanding of the root causes and control breakdowns that lead to member, provider, and state complaints/issues. This role works directly with local plan leadership and ensures key interactions with the Louisiana Department of Health are appropriately addressed. How You Will Make an Impact: Tracker of issue remediation, confirming our business partners understand and address the root cause and control breakdowns that lead to member, provider, and state complaints/issues. Reviewing state defined quality metrics performance, vendor and affiliate monitoring and audit performance. Oversee health plan implementation of new local and enterprise-wide initiatives. Researches and responds to questions about requirements in the contract, and state-based interpretation and enforcement of those requirements and owns the Louisiana Medicaid Compliance Committee. Supports business development and maintenance of the contract through request for proposal support; supports health plan leaders with business operational reviews with senior Medicaid leadership. Meets with key regulatory contacts biweekly or more often as needed, ensuring the health plan is meeting regulatory expectations. Supports Elevance’s Audit COE in understanding the state requirements that are being audited against, and the key state health plan leaders (local and centralized) responsible for each area of the audit. Review collateral and member messaging developed that would be distributed to members for the state (local, compliance related, and centralized). Performs reviews of policies and procedures developed locally, and for centralized support to ensure compliance with state contracts. Minimum Requirements: Requires a BA/BS and minimum of 6 years health care, regulatory, ethics, compliance or privacy experience; or any combination of education and experience, which would provide an equivalent background. Preferred Skills, Capabilities, and Experiences: Managed care operations experience highly preferred. Strong leadership/managerial skills and ability to motivate/coach other staff strongly preferred. MS/MBA or professional designation preferred. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact View email address on click.appcast.io for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration. #J-18808-Ljbffr Elevance Health