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Senior Compliance Consultant

Primary Location: Southfield, MI
Additional Locations: MI-Southfield
Experienced / career level compliance position that applies compliance, business, analytical and communication skills to support, manage and help develop compliance programs and processes that promote compliant and ethical behavior, meet regulatory obligations and prevent, detect and mitigate compliance risks.

Fundamental Components:
Independently demonstrates the principles of an effective Compliance program, including, but not limited to, risk assessment, auditing and monitoring, maintaining effective compliance policies and procedures, and effective communication and training.
  • Manages all facets of the organizations Utilization Review Accreditation Commission (URAC) accreditation process including performing all annual due diligence audits and monitoring of activities ensuring all, documentation and evidence necessary for the accreditation are prepared in compliance with accreditation standards, contractual agreements, and State and Federal requirements.
  • Maintains responsibility for ensuring that all State/Joint Commission Standards related to licensure are being met.
  • Draft, review, and/or recommend as necessary, updates policies and procedures based on new or revised changes in regulations and standards.
  • Responsible for independent action in project oversight, quality improvement and a variety of special projects. Uses Six Sigma, LEAN, and/or other available performance improvement methodologies to achieve these goals.
  • Applies industry and compliance knowledge to support and manage moderately complex matters involving established compliance system and operations, including processes for implementation of laws and regulations, supports the Company’s Privacy Office on privacy matters monitoring of compliance issues, and handling of moderately complex complaints.
  • Responds to moderately complex requests for information within area of responsibility from internal and external constituents. Independently collects the facts related to an issue, performs analysis and effectively prepares and communicates concise summaries on moderately complex matters.
  • Acts as resource for colleagues and effectively guides less experienced team members to accomplish goals.

Background Experience:
  • 5 years+ experience in a regulatory compliance position in healthcare
  • Clinical knowledge or RN preferred
  • Knowledge of CMS, HIPAA and URAC regulations and standards
  • Motivated, conscientious individual who enjoys challenges, takes the initiative, and able to demonstrate ability to handle multiple assignments simultaneously, in a timely manner, with minimal supervision
  • Must be a well-organized, reliable, enthusiastic individual to review, monitor, and evaluate policy & workflow as part of the accreditation process
  • Bachelor's degree or equivalent experience

Required Skills:
Leadership - Collaborating for Results, Leadership - Driving a Culture of Compliance, Service - Creating a Differentiated Service Experience

Functional Skills:
Lega - Compliance, Management - Management - Project management (non-IT)

Potential Telework Position:

Percent of Travel Required:
0 - 10%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
Benefit eligibility may vary by position.

Candidate Privacy Information:
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

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