Regulatory and Licensing Senior Analyst - AZ Hybrid - Evernorth Care Group

Purpose of Position: Regulatory and licensing analysts examine, evaluate, and investigate compliance with laws and regulations governing licenses, established standards, and perform other risk mitigation and enforcement inspections and analysis activities as directed. This position will support clinical regulatory adherence.

Position Summary: The Regulatory and Licensing Senior Analyst is an important member of the Quality team within Evernorth Care Group, supporting Facility & Clinical Licensing processes and survey readiness along with other high-impact projects across the department.

Work hours: Typically, Monday-Friday 8 a.m.-5 p.m. Some hours may vary based on the department needs. Work from home intermittently.

Primary Job Duties and Responsibilities:

Facility Licensing/Regulatory

• Licensing management by processing and submitting initial, renewal, and amendment license applications and payments within the required time frames.
• Analyze, verify, interpret, and track documentation required in support of facility and clinical license applications, permits, and registrations.
• Demonstrate, maintain knowledge and ensure organization compliance of regulatory and accrediting agencies’ standards related to outpatient clinical services.
• Respond to requests regarding application status and processes related to business licensure.
• Provides subject matter expert clinical guidance on licensing and regulatory requirements, industry standards, and best practices.
• Assists in the development of policies and procedures and may recommend changes in processing procedures.
• Coordinates credentialing reporting systems to monitor clinical licensing, certifications, credentialing/re-credentialing activity, delegation oversight, and sanction monitoring

Survey Readiness (HCCR)

• Conducts provider site audits and clinical medical record reviews to assess compliance with state regulations and corporate policies. 
• Responsible for identifying regulatory and standards vulnerabilities and determine escalation level, if necessary.
• Guides the development, communication, implementation and tracking of site action plans necessary to close identified gaps in care of compliance and patient safety.
• Reviews regulatory and licensing information/data with operational front line and operational leadership including but not limited to quality and deskside reviews, operational quality metrics, and clinical outcomes metrics.
• Ongoing management of continuous survey readiness across the organization.

General

• Applies standard techniques and procedures to routine instructions that require professional and clinical knowledge in specialist areas.
• Provides standard professional advice and creates initial reports/analyses for clinical site review.
• May provide guidance, coaching, and direction to more junior members of the team.
• May be directly involved in complex credentialing and state licensure audits.
• Supports implementation of quality and patient safety goals, policies, procedures, and activities designed to meet the requirements of regulatory and accrediting agencies.
• Additional duties as assigned.

Education and Experience Requirements:

• Current nursing license with Associate Degree in Nursing or higher.
• 3+ years recent experience as a nurse in primary care or outpatient clinic care.
• Knowledge of state/federal regulatory requirements and accreditation standards
• Ability to identify challenges or process improvement opportunities, particularly in a clinical setting, determine potential solutions and carry out to timely resolution.
• Excellent communication skills, ability to receive large amount of information, providing clear detailed analysis, status, and/or recommendations across a range of projects and initiatives.
• Ability to appropriately prioritize work, and strong time management skills with excellent follow up on tasks.
• Pays attention to small details, identifies errors, and maintains high levels of accuracy when working with data.
• Works under own initiative, prioritizes own work, manages multiple projects, and meets agreed timescales while maintaining a high level of accuracy.
• Experience with MS Office programs including Outlook, Word, Excel, and PowerPoint.

Preferred Experience:

• 1+ year experience in quality management or regulatory oversight
• 2 + years of experience in licensing and clinical support field
• Project Management experience

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fi