Senior Manager, Compliance Program Admin

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
 

*Applicants for this job have the flexibility to work remote from home anywhere in the Continental United States*

Position Purpose: Manage and implement strategies to ensure successful maintenance and implementation of compliance programs that meet regulatory requirements for assigned products across the entire company

• Ensure all Medicare and Medicaid product and services are being tested for compliance with program regulations, insurance regulations, and regulatory requirements for business entities.
• Maintain and track laws and regulations, contract documentations, amendments, and various compliance measures.
• Develop policies, procedures, and process to comply with federal program regulations, and any applicable state regulations.
• Provide guidance to various departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contract language.
• Conduct compliance audits, develop and implement corrective action plans.
• Perform plan risk assessments and report emerging trends, deficiencies and variances; report findings to other departments and teams as appropriate.
• Provide required Ethics, Compliance, Risk Management, FWA, privacy, and security training for existing and new employees and as required non-employees.
• Provide mentoring and guidance to subordinates within the department as necessary.
• Serve as primary backup to department lead as necessary.

Commercial Insurance (additional responsibilities):

• Monitor Commercial product risks in accordance with the risk reporting policies.
• Manage Benefit Filings and entity licensures for all products to ensure compliance with state and federal regulatory requirements.
• Work in collaboration with Marketing teams to monitor Sales & Marketing representatives and materials used in advertisements.

Medicare (additional responsibilities):

• Monitor the FDR oversight program to ensure all Medicare and MMP plans are conducting the appropriate oversight in a timely manner.
• Report all Medicare and Medicaid product risks in accordance with the risk reporting policies.
• Partner with various departments as the local executive responsible for ensuring that state and/or federal regulatory requirements relating to business continuity and disaster recovery are communicated and met.

Knowledge/Experience: Bachelors’ degree in related field or equivalent experience. Master's or Juris Doctorate degree preferred. 5+ years of compliance experience, preferably in a healthcare environment with at least 3+ years of Medicaid, Medicare or Commercial Managed Care experience. Previous experience demonstrating effective interaction with federal and state regulatory agencies in a managed care or insurance environment preferred.
Corporate: Bachelors’ degree, CPA, CISA, JD, MHA, MBA, MIS, or similar preferred or equivalent experience. 5+ years of experience implementing business initiatives in process, risk, and control measures

Pay Range: $107,700.00 - $199,300.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act