Medicaid Compliance Strategist

Cigna Group; Franklin (TN); Hybrid; USD 96,000 - 160,000; Full time

Benefits offered by this job

Medical, vision, dental

401(k)

Life insurance

Tuition reimbursement

Paid time off 18 days

Paid holidays

Job summary

The Cigna Group seeks a Legal Compliance Advisor to lead Medicaid regulatory compliance, audits, and guidance across Compliance, Legal, Government Affairs, and business teams. You will help identify risks, interpret complex regulations, and provide strategic guidance to stakeholders in a dynamic health services environment.

With 5+ years in healthcare compliance and a strong regulatory background, you will serve as a SME for Medicaid issues, drive corrective actions, and collaborate across

Qualifications

• Bachelor's degree required; JD, Master's degree in a healthcare-related field, Paralegal Certificate, or active RN license preferred.
• 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.
• Clinical experience as an RN within managed care, utilization management, case management, or health plan operations is preferred.
• Strong analytical, communication, project management, and problem-solving skills.

Responsibilities

• Perform and oversee second line of defense Medicaid regulatory audits to identify regulatory and compliance risks and report findings to stakeholders for remediation.
• Ensure compliance with state and federal laws and regulations.
• Provide day-to-day Medicaid regulatory guidance to stakeholders.
• Provide necessary notification to stakeholders on updated Medicaid contracts and regulations.
• Key Medicaid presenter in regulatory and new law oversight committees.
• Identify Medicaid regulatory compliance trends and risk to the company through analysis and engagement.
• Participate in client regulatory audits to observe and provide Medicaid regulatory guidance.
• Be recognized internally as a subject matter expert.
• Advise functional leaders using deep professional knowledge and acumen.
• Contribute to broader projects requiring understanding of the wider business.

Skills

Analytical skills

Communication skills

Project management

Problem solving

Education

Bachelor's degree

Juris Doctor (JD)

Master's in healthcare

Paralegal Certificate

RN license

Tools

Regulatory databases

Job description

The Cigna Group seeks a Legal Compliance Advisor to lead Medicaid regulatory compliance, audits, and guidance across Compliance, Legal, Government Affairs, and business teams. You will help identify risks, interpret complex regulations, and provide strategic guidance to stakeholders in a dynamic health services environment.

With 5+ years in healthcare compliance and a strong regulatory background, you will serve as a SME for Medicaid issues, drive corrective actions, and collaborate across