Legal Compliance Senior Advisor - Commercial

Legal Compliance Sr.

Advisor - Commercial

As a senior individual contributor within EviCore's Commercial Compliance department, this role is pivotal in shaping and executing the organization's compliance strategy.

The position operates cross-functionally with Compliance, Legal, Government Affairs, and business stakeholders, ensuring robust Commercial compliance programs and adherence to applicable state and federal regulations, as well as accreditation requirements.

Key Responsibilities


* Serve as the recognized Commercial Compliance subject matter expert (SME), providing advanced regulatory and reporting guidance to internal stakeholders


* Lead and support second line of defense audits, identifying and reporting areas of non-compliance and risk, and ensuring effective preventative measures are in place


* Deliver day-to-day Commercial guidance and timely notifications on updated contracts and regulations


* Identify and analyze Commercial regulatory compliance trends and risks, leveraging data and engagement to inform leadership


* Participate in client regulatory audits to observe and provide Commercial regulatory guidance


* Advise functional leaders and contribute thought leadership within Compliance, while engaging in broader projects that require a deep understanding of the business


* Key presenter in EviCore's regulatory and new law oversight committees

Qualifications


* Bachelor's degree required.

Juris Doctor (JD), master's in health-related field, or paralegal certificate preferred


* 7+years of experience in the healthcare industry with a focus on healthcare utilization management


* Demonstrated expertise in interpreting and implementing healthcare-related state and federal laws and regulations


* Proven ability to engage strategically with legal and business resources to ensure accurate and effective application of law and regulation


* Experience developing and leveraging processes for tracking, coordinating, and collaborating on health plan and hospital system audits, monitoring, and corrective actions


* Strong analytical, problem-solving, and communication skills, with the ability to manage multiple projects to timely completion


* Ability to work collaboratively and foster strong relationships in a large, matrixed organization


* Independent decision-making capability


* Proficiency in Microsoft Word, Outlook, PowerPoint, and Excel


* Knowledge of Smartsheet and Adobe (PDF) applications is preferred

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an annual salary of 108,500 - 180,900 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an ...