15 days old

Insurance Utilization Review Lead/Regulatory Compliance

Accenture is a leading global professional services company, providing a broad range of services and solutions in strategy, consulting, digital, technology and operations. Combining unmatched experience and specialized skills across more than 40 industries and all business functions underpinned by the worlds largest delivery network Accenture works at the intersection of business and technology to help clients improve their performance and create sustainable value for their stakeholders. With approximately 469,000 people serving clients in more than 120 countries, Accenture drives innovation to improve the way the world works and lives. Visit us at www.accenture.com.

People in our Client Delivery & Operations career track drive delivery and capability excellence through the design, development and/or delivery of a solution, service, capability or offering. They grow into delivery-focused roles, and can progress within their current role, laterally or upward.

Job Description
The Insurance Utilization Review Lead/Regulatory Compliance Lead will be responsible for managing the utilization review and third-party administrator licensure activities for specific states. This includes:
Monitoring state and federal laws that may affect business.
Evaluates, interprets, and summarizes state regulatory guidelines and changes to guidelines.
Works in conjunction with the Regulatory Manager and works with legal SME s e.g., data privacy, health regulatory for interpretation of applicable laws.
Tracks applicable utilization review and third-party administrator laws
Consults regulatory updating services databases
Consults reviews legal research, partners with shared service legal SMEs regarding changes in laws
Ensures timely submissions of utilization review and third-party administrator renewals and reports
Assists with the creation and maintaining systems, tools, timetables and schedules to ensure the appropriate tracking of utilization review and third-party administrator renewal licenses and reports.
Compiles all materials required for application submission, development and submission of reporting requirements to state licensing bodies.
Works with internal and external departments to obtain the necessary information for filing
Submits renewal applications and reports timely
Prepares regulatory filings
Responds to regulator inquiries
Maintains state specific policies
Assists Regulatory Manager with the creation and updating of business policies to reflect changes in applicable laws.
Makes changes to state specific addenda as the utilization review laws are modified by each state and federal agencies.
Assists in tracking state laws for individual health care professional licensing i.e. nurse, physician and assists in coordinating and completing individual filings and developing licensing strategy.
Employees are required to maintain compliance with company safety, security and privacy programs secrecy

Basic Qualifications:
US Registered Nurse, Juris Doctor, or Paralegal degree
3 years of experience in the medical or health insurance field

Preferred Qualifications:
Utilization review/utilization management experience
Third Party Administrator experience
Experience creating and updating policies
Professional Skills Requirements:
Strong user of MS Office suite
Excellent written and communication skills
Demonstrates teamwork and collaboration skills in a professional setting

All of our professionals receive comprehensive training covering business acumen, technical and professional skills development. You'll also have opportunities to hone your functional skills and expertise in an area of specialization. We offer a variety of formal and informal training programs at every level to help you acquire and build specialized skills faster. Learning takes place both on the job and through formal training conducted online, in the classroom, or in collaboration with teammates. The sheer variety of work we do, and the experience it offers, provide an unbeatable platform from which to build a career.

Applicants for employment in the US must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States and with Accenture.Candidates who are currently employed by a client of Accenture or an affiliated Accenture business may not be eligible for consideration.Accenture is a federal contractor and an EEO and Affirmative Action Employer of Females/Minorities/Veterans/Individuals with Disabilities.Equal Employment OpportunityAll employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law.Job candidates will not be obligated to disclose sealed or expunged records of conviction or arrest as part of the hiring process.Accenture is committed to providing veteran employment opportunities to our service men and women.


Posted: 2019-10-28 Expires: 2019-12-04

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Insurance Utilization Review Lead/Regulatory Compliance


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