Legal Advisor, Healthcare Regulatory Compliance

🔥 5 minutes ago

🇺🇸 United States – Remote

💵 $96.2k - $160.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚖️ Legal Counsel / General Counsel

👻 Ghost score 0%

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The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛡️ Insurance

Healthcare • Insurance

The Cigna Group is a global health services company that provides medical, dental, pharmacy, behavioral and supplemental insurance products and benefits to individuals, families, employers, brokers, providers and Medicare beneficiaries. It offers employer-sponsored group plans, individual and family plans (including Open Enrollment offerings), Medicare, international health insurance covering more than 200 countries, and digital member services through the myCigna platform (including telehealth and claims management). Its products are delivered through operating subsidiaries such as Cigna Health and Life Insurance Company and other regional affiliates.

📋 Description

• Work cross-functionally with Compliance, Legal, Government Affairs, and business stakeholders • Own EviCore’s Medicaid Compliance program and processes • Perform and oversee second-line-of-defense Medicaid regulatory audits • Identify and report regulatory and compliance risks and findings for remediation • Ensure compliance with state and federal laws and regulations • Provide day-to-day Medicaid regulatory guidance to stakeholders • Notify stakeholders about updated Medicaid contracts and regulations • Present Medicaid matters in regulatory and new-law oversight committees • Identify Medicaid regulatory compliance trends and company risk through analysis and engagement • Participate in client regulatory audits and provide Medicaid regulatory guidance • Serve as an internal Medicaid subject matter expert • Advise functional leaders using deep professional knowledge • Provide thought leadership within Compliance and contribute to broader business projects

🎯 Requirements

• Bachelor's degree required • 5+ years of healthcare compliance, regulatory affairs, utilization management, managed care, or related healthcare experience • Experience supporting Medicaid, Commercial, Medicare, or other government-sponsored healthcare programs • Strong knowledge of healthcare regulatory requirements, utilization management regulations, accreditation standards, and compliance best practices • Experience interpreting regulations, conducting compliance audits, monitoring activities, risk assessments, and corrective action oversight • Ability to analyze regulatory requirements and provide guidance to business, operational, clinical, and legal stakeholders • Experience partnering cross-functionally with Compliance, Legal, Operations, Government Affairs, and business leaders • JD, Master's degree in a healthcare-related field, Paralegal Certificate, or active RN license preferred • Clinical experience as an RN within managed care, utilization management, case management, or health plan operations preferred • Strong analytical, communication, project management, and problem-solving skills • For home working, cable broadband or fiber optic internet service with at least 10 Mbps download and 5 Mbps upload required

🏖️ Benefits

• Annual bonus plan eligibility • Medical, vision, and dental benefits starting on day one • Well-being and behavioral health programs • 401(k) • Company-paid life insurance • Tuition reimbursement • Minimum of 18 days of paid time off per year • Paid holidays • Leaves of absence • Remote work arrangement • Internet connection requirement/support for home working through cable broadband or fiber optic service