Aetna Compliance Consultant in Boston, Massachusetts
Req ID: 52490BR
This is an exciting opportunity to join the newly formed Clinical Operational Excellence Business Integrity Unit. The Compliance Consultant promotes and enforces compliance with state/federal laws and regulations and related-company policies (including the Aetna Code of Conduct) affecting Aetna businesses and encouraging high business standards in order to advance company objectives, benefit the company's customers, employees and shareholders, and protect the company's reputation. Responsibilities include: auditing, investigating, training/education and enforcement, ongoing consultation on compliance issues impacting clinical business areas, monitoring and reporting on adherence to compliance controls, recommending and helping businesses to implement compliance controls.
This role will report directly to the Director Compliance, and work with team members of the Business Integrity Team building successful relationships with stakeholders, clinical services, regulatory, commercial compliance, and other parties as necessary. Oversees compliance activities in support of a large or complex business group and/or manages teams responsible for managing audits Works closely with management to drive compliance as a core competency and integrate compliance into business plans, scorecards, metrics and processes; removes barriers to implementation. This is partnership with clinical business areas to focus on understanding scope of business and partner with plan to achieve business needs while maintaining compliance. Assures the timely implementation of corrective action plans applicable to assigned business areas. Ensures that compliance risks are addressed and corrective actions are taken, as appropriate; Assists business units with development and promulgation of appropriate compliance controls/corrective actions. Oversees or ensures the development of policies and procedures needed in response to new or existing laws or Company policies. Monitors ongoing compliance with the policies and procedures within the business area Conducts investigations of compliance deviations or failures. Promotes compliance reviews and risk assessments Promotes and enforces Aetna's Code of Conduct and Integrity The Aetna Way Promotes compliance awareness, education and training Assists with communicating the Company's business conduct, integrity and compliance messages Supports establishes compliance education programs and provides and/or promotes continuing training & education Assures compliance direction is aligned with segment clinical business strategies
2-4 years experience in a regulatory compliance position in healthcare, insurance or financial services or relevant work experience in a business area.
Previous clinical audit experience preferred.
Possessing Project Management skills is a plus.
Experience with Quick Base preferred.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Legal/ is desired
Medical Management/ is desired
Functional - Legal/Compliance/1-3 Years
Functional - Legal/Compliance - training/education/1-3 Years
Functional - Medical Management/Medical Management - Clinical coverage and policies/1-3 Years
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
Technical - Desktop Tools/Microsoft Word/1-3 Years/End User
Technical - Desktop Tools/TE Microsoft Excel/1-3 Years/End User
General Business/Applying Reasoned Judgment/FOUNDATION
Leadership/Driving a Culture of Compliance/FOUNDATION
Service/Working Across Boundaries/FOUNDATION
Leadership/Anticipating and Innovating/FOUNDATION
General Business/Maximizing Work Practices/ADVANCED
Considered for current internal teleworkers (in any area)
Office based in any location considered
ADDITIONAL JOB INFORMATION
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna takes our candidates'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.
Job Function: Legal