Clinical Compliance Manager

Anticipated End Date:

2025-11-21

Position Title:

Clinical Compliance Manager

Job Description:

Clinical Compliance Manager

Location: Washington, DC. This role requires associates to be in-office 4 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of remote work, promoting a dynamic and adaptable workplace. Alternate locations may be considered.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

The Clinical Compliance Manager will be responsible for supporting clinical regulatory compliance for lines of business enterprise wide or complex state, delegated entities and/or subsidiaries through project leadership, technical oversight and risk identification and mitigation.

How you will make an impact:

• Serves as the point of contact, coordinating and collaborating with regulatory bodies and business partners to ensure compliance with regulatory, accrediting and Health Plan quality of care and service requirements.

• Develops tools that assist in determining exposure to regulatory and accreditation risks. Identifies opportunities to manage and mitigate those risks.

• Works with business management areas to develop metrics for monitoring program objectives and policies and procedures that support compliance with regulatory and accreditation standards.

• Compiles information related to quality improvement and compliance monitoring activities, and maintains relevant records.

• Provides guidance and oversight to business unit audit functions to ensure ongoing regulatory and accreditation compliance, and monitors corrective action plans relating to regulatory and accreditation compliance.

• Makes recommendations to business unit partners for improvements or remediation to risk management, regulatory, and accreditation compliance programs.

• Monitors development and use of metrics for regulatory and accreditation compliance.

• Monitors business unit initiatives relating to the development and implementation of a risk management program for utilization management activities.

• Collaborates with enterprise quality teams, enterprise care management teams, and other clinical departments on regulatory initiatives.

• Supports quality committee activities. Leads department projects, and mentors clinical compliance staff.

Minimum Requirements:

• Requires a BA/BS and minimum of 5 years experience, including minimum of 3 years regulatory, compliance or accreditation, and auditing experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• RN preferred.

• Travels to worksite and other locations as necessary.

• Knowledge of clinical regulatory requirements, such as those of state regulatory agencies, accreditations, and CMS strongly preferred.

For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $96,324 - $144,486

Locations: District of Columbia (Washington, DC)

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company.  The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.  

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form o