Legal Advisor, Healthcare Regulatory Compliance

🔥 12 hours 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

Founded 1982

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare • Healthcare Insurance • Pharmaceuticals

The Cigna Group is a global health company committed to improving the health and vitality of its clients, customers, and patients. With its two divisions, Cigna Healthcare and Evernorth Health Services, the company focuses on enhancing quality of life through healthcare services and pharmacy benefits management. The Cigna Group is dedicated to ethical practices in healthcare and artificial intelligence, and strives to create positive change in the healthcare system. It also emphasizes its Environmental, Social, and Governance (ESG) responsibilities, aiming to impact health equity and foster innovation in healthcare delivery.

📋 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 non-compliance and risk areas to stakeholders for remediation • Analyze data to ensure preventative measures effectively mitigate risk • 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 risks 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 • Strong analytical, communication, project management, and problem-solving skills • Internet connection through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload when working at home • JD, Master's degree in a healthcare-related field, Paralegal Certificate, or active RN license preferred • Clinical RN experience within managed care, utilization management, case management, or health plan operations preferred

🏖️ Benefits

• 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 • Annual bonus plan eligibility • Remote work arrangement • Cable broadband or fiber optic internet requirement for working at home