Compliance Director KanCare

Location: Open to the State of Kansas.

Candidates must reside within 50 miles or 1-hour commute each way of the Topeka or Overland Park Kansas Elevance Health Pulse Point locations.

This position will take part in Elevance Health's hybrid workforce strategy which includes virtual work and 1-3 days in office per week.

The Plan Compliance Director owns oversight to ensure monitoring is performed in compliance with the Kansas state contract requirements and connects with state plan leaders and centralized government business process leaders to understand business level monitoring of compliance with state requirements. 

How You Will Make an Impact

Primary duties with expert skill level and tasks with the most advanced complexity and broad/enterprise scale may include, but are not limited to:

• Reviewing state defined quality metrics performance, vendor and affiliate monitoring and audit performance.

• Regulatory monitoring and research, overseeing regulatory audits or exams, regulatory filings, executive-sponsored initiatives, risk assessments, conducting mock audits, conducting audit training, assessing audit preparedness.

• The central driver 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. 

• Researches and responds to questions about requirements in the contract, and state-based interpretation and enforcement of those requirements and owns the Kansas 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 the 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.

• Leads compliance monitoring to identify and address compliance risks and manage action plans designed to fully mitigate risk(s).

• Develop strong relationships with key leaders to ensure company and subsidiaries have thorough, accurate regulatory information on which to base business decisions.

​ Minimum Requirements:

• Requires a BA/BS and minimum of 8 years health care, regulatory compliance or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

• Kansas compliance knowledge highly preferred.

• Strong leadership/managerial skills and ability to motivate/coach other staff strongly preferred.

• MS/MBA/JD or professional designation preferred.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

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 elevancehealthjobssupport@elevancehealth.com for assistance.