DESCRIPTION

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.

EDUCATION/EXPERIENCE:

• 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.

Leads the integrity and governance of Centene’s and/or its vendors corporate ethics and compliance program, and 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 through structured oversight and monitoring of government-sponsored healthcare programs.
• Oversee the management of the entire contract lifecycle, from drafting to finalization, ensuring compliance and mitigating risks.
• Conducts reviews, audits, and assessments of vendor relationships to ensure adherence to Centene’s s and Government-sponsored health care program Requirements.
• Collaborates with business owners and vendors to drive process improvements, maintaining integrity, and ensuring compliance with Government-sponsored healthcare program requirements.
• Leads the timely, consistent, and accurate communication of state and federal regulatory updates impacting Medicaid and Marketplace regulatory filings in collaboration with market and product compliance officers. Prepares, organizes, and package 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, including the inclusion of sufficient evidence to substantiate findings.
• 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.
• Performs other duties as assigned.
• Complies with all policies and standards.