United States onlyYou 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 role have the flexibility to work remotely 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
- Responsible for the on-going development and refinement of the payment integrity program including creating and revising policies and procedures and assisting with the development and implementation of training programs.
- Investigate payment integrity issues and mitigate any potential violation of the regulations including gathering information and recommend a course of action, prepare reports by researching, analyzing and summarizing information and monitor legislation and regulations affecting the organization’s privacy practices.
- Develop, implement and maintain production and quality standards for the compliance program with a focus on privacy.
- Perform periodic audits, risk assessments and conduct related ongoing compliance monitoring activities.
- Evaluate and implement changes to service functions and performance in relation to company mission, philosophy objectives and policies.
- Plan, direct and coordinate the implementation of policy decisions and ensure compliance with the company’s strategic plan, establish the department’s strategic vision, objectives and attendant policies and procedures for the organization.
- Research and incorporate best practices into operations and ensure that department functions are coordinated with other operating departments.
Education/Experience:
- Bachelors’ degree in related field or equivalent experience. Master's or Juris Doctorate degree preferred.
- 4+ years of compliance experience, preferably in a healthcare environment with at least 2+ years of Medicaid, Medicare or Commercial Managed Care experience.
- Previous experience demonstrated effective interaction with federal and state regulatory agencies in a managed care or insurance environment preferred.
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. Total compensation may also include additional forms of incentives.
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
