Job Description:
• Leads the integrity and governance of Centene's and/or its vendors corporate ethics and compliance program
• ongoing oversight and analysis of regulatory compliance practices
• Collaborates with internal teams and external vendors or subcontractors to promote contract compliance and uphold program integrity
• Oversee the management of the entire contract lifecycle, from drafting to finalization
• Conducts reviews, audits, and assessments of vendor relationships to ensure adherence to Centene and Government-sponsored health care program Requirements.
• Collaborates with business owners and vendors to drive process improvements
• Leads the timely, consistent, and accurate communication of state and federal regulatory updates impacting Medicaid and Marketplace regulatory filings
• Prepares, organizes, and packages subcontractor files for approval/notification
• Develop clear, accurate and timely written reports detailing oversight and monitoring findings and recommendations
• Ensures all supporting documentation and workpapers meet Centene and department standards
• Partners with internal departments and subcontractors to route compliance concerns to the appropriate channels for investigation and resolution
• Supports regulatory notifications and documentation of approvals/notifications
Requirements:
• Bachelor's Degree in related field; or, equivalent experience required
• Master's Degree preferred
• Juris Doctor (JD) preferred
• 4+ years Managed Care/Health Insurance and knowledge of relevant legal and regulatory frameworks required
• 2+ years Project oversight with demonstrated ability to drive implementation and influence others preferred
• 2+ years Reading, analyzing, and interpreting State and Federal laws, rules and regulations preferred
• 2+ years State Medicaid or government sponsored healthcare compliance preferred
• HealthCare Compliance (CHC) preferred
Benefits:
• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• flexible approach to work with remote, hybrid, field or office work schedules
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