Legal Clinical Quality Compliance Advisor

The job profile for this position is Legal Compliance Advisor, which is a Band 4 Senior Contributor Career Track Role.

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We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply!

Our people make all the difference in our success.

The Clinical & Regulatory Compliance Advisor supports Evernorth Care Delivery & Pharmacy + Compliance in implementing and managing an effective healthcare regulatory compliance program across multiple Cigna & Evernorth entities.

Responsibilities:

• Partner with the leadership to implement and maintain a healthcare compliance program that promotes a culture of compliance and patient safety
• Oversee ongoing testing and monitoring processes to improve program effectiveness
• Collaborate across departments to route compliance issues appropriately (e.g., clinical complaints, privacy, ethics)
• Participate in prevention, detection, and correction of compliance issues (e.g., chart reviews, clinician interactions, billing audits)
• Review and help develop policies to ensure compliance with federal and state laws
• Identify compliance risks and implement corrective actions
• Provide regular reports to senior management on compliance operations and progress

Qualifications:

• College degree, healthcare compliance certification, or equivalent experience
• Healthcare provider licensure (RN, NP, RPh, PA) or equivalent clinical/quality experience
• 5+ years in a care delivery setting (in-person or virtual), with knowledge of medical group/specialty practices, urgent care, and employer-site clinics
• Familiarity with billing/coding standards, accreditation, and quality programs preferred
• Basic understanding of payer regulations (Medicare FFS, Medicare Advantage, Medicaid)
• Strong written and verbal communication skills
• Ability to work independently and manage multiple priorities
• Detail-oriented with analytical skills for regulatory/business data
• Self-starter with a growth mindset
• Collaborative and influential team player

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an annual salary of 96,200 - 160,400 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

Please note that you must meet our posting guidelines to be eligible for consideration.  Policy can be reviewed at this link.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.