Compliance and Licensing Specialist

Nashville, TN (HYBRID)

Job Summary

The Compliance and Licensing Specialist is responsible for the management of all licensing for Lucent Health and its’ subsidiaries. The primary purpose of the position is to maintain the company’s compliance with Federal and State licensing rules and regulations, in addition to securing new licenses as required. S/he is also responsible for filing associated annual reports for licenses. Written and verbal coordination with the LHCM (a Lucent Health subsidiary) clinical team is required for all Utilization Review licenses. Candidate must be able to manage workflow, multiple tasks at once, and work well within a designated deadline requirement.

• Work with First Consulting Associates (FCA) to maintain current TPA licenses – 30%
• Work with LHCM staff to maintain all State UR Licenses/Tracking – 25%
• Submit State Surcharge reports for the company – 25%
• Work with Cogency to maintain State registrations TPA and UR – 15%
• Track and handle Secretary of State (SoS) annual filings as needed – 5%

• Critical to keeping the Company compliant with all State and Federal regulations.
• Centralized tracking system for all licenses to help protect the Company and ensure timely renewal submissions.
• In collaboration with Utilization Review and Compliance leads, maintenance of TPA and UR licenses.
• Mitigate any potential risks to the organization

• Minimum of 3 years’ experience using Microsoft Office Suite and, Smartsheet and similar applications
• Organization, strategic thinking, and reasoning abilities to figure out more than one way to get to the desired results.
• Competence to understand legal Corporate structures and their differences, highly desired.
• Proficient in EMRE/Care Management platforms
• Demonstrated knowledge of legal and ethical issues related to confidentiality, including HIPAA and state specific privacy laws.
• Previous experience with utilization review, policy writing, license compliance, MCG guidelines, and URAC experience preferred.
• One (1) year minimum experience or familiarity working with State and Federal officials and medical license requirements, preferred.

Qualifications:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience:
Bachelor’s degree (B.A.) from four-year college or university; or a minimum of four

(4) years healthcare industry related experience and/or training; or equivalent combination of education and experience.

Lucent Health Solutions, Inc. is an Equal Opportunity Employer that does not discriminate based on actual or perceived race, creed, color, religion, alienage or national origin, ancestry, citizenship status, age, disability or handicap, sex, marital status, veteran status, sexual orientation, genetic information, gender identity, gender expression, transgender status, arrest record, or any other characteristic protected by applicable federal, state or local laws. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.