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Legal Advisor, Healthcare Regulatory Compliance
The Cigna Group. Work cross-functionally with Compliance, Legal, Government Affairs, and business stakeholders .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates extensive knowledge of Medicaid compliance and regulatory requirements, with a strong ability to analyze regulations and provide guidance to stakeholders. Proven experience in conducting compliance audits, risk assessments, and leading cross-functional collaboration within healthcare environments.
Highest-signal resume keywords
Medicaid Compliance Program ManagementHealthcare Regulatory AuditsRegulatory Risk AssessmentCross-Functional CollaborationHealthcare Compliance Expertise
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Healthcare ComplianceRegulatory AffairsUtilization ManagementCompliance AuditsRisk AssessmentRegulatory GuidanceData AnalysisAccreditation StandardsMedicaid RegulationsGovernment-Sponsored Healthcare Programs
Soft Skills
Analytical SkillsCommunication SkillsProject ManagementProblem-Solving Skills
Certifications & Qualifications
Bachelor's DegreeJDMaster's Degree in HealthcareParalegal CertificateActive RN License
Industry Keywords
MedicaidHealthcare ComplianceRegulatory RequirementsManaged CareClinical ExperienceGovernment AffairsStakeholder EngagementCompliance Best PracticesHealthcare ProgramsUtilization Management Regulations
About the role
Key responsibilities & impact- Work cross-functionally with Compliance, Legal, Government Affairs, and business stakeholders
- Own EviCore’s Medicaid Compliance program and processes
- Perform and oversee second-line-of-defense Medicaid regulatory audits
- Identify and report regulatory and compliance risks and findings for remediation
- Ensure compliance with state and federal laws and regulations
- Provide day-to-day Medicaid regulatory guidance to stakeholders
- Notify stakeholders about updated Medicaid contracts and regulations
- Present Medicaid matters in regulatory and new-law oversight committees
- Identify Medicaid regulatory compliance trends and company risk through analysis and engagement
- Participate in client regulatory audits and provide Medicaid regulatory guidance
- Serve as an internal Medicaid subject matter expert
- Advise functional leaders using deep professional knowledge
- Provide thought leadership within Compliance and contribute to broader business projects
Requirements
What you’ll need- Bachelor's degree required
- 5+ years of healthcare compliance, regulatory affairs, utilization management, managed care, or related healthcare experience
- Experience supporting Medicaid, Commercial, Medicare, or other government-sponsored healthcare programs
- Strong knowledge of healthcare regulatory requirements, utilization management regulations, accreditation standards, and compliance best practices
- Experience interpreting regulations, conducting compliance audits, monitoring activities, risk assessments, and corrective action oversight
- Ability to analyze regulatory requirements and provide guidance to business, operational, clinical, and legal stakeholders
- Experience partnering cross-functionally with Compliance, Legal, Operations, Government Affairs, and business leaders
- JD, Master's degree in a healthcare-related field, Paralegal Certificate, or active RN license preferred
- Clinical experience as an RN within managed care, utilization management, case management, or health plan operations preferred
- Strong analytical, communication, project management, and problem-solving skills
- For home working, cable broadband or fiber optic internet service with at least 10 Mbps download and 5 Mbps upload required
Benefits
Comp & perks- Annual bonus plan eligibility
- Medical, vision, and dental benefits starting on day one
- Well-being and behavioral health programs
- 401(k)
- Company-paid life insurance
- Tuition reimbursement
- Minimum of 18 days of paid time off per year
- Paid holidays
- Leaves of absence
- Remote work arrangement
- Internet connection requirement/support for home working through cable broadband or fiber optic service