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.
Position Purpose: Provides strategic leadership and management and serves as a subject matter expert for the Compliance strategy for Dual Special Needs Plans (DSNPs), ensuring alignment with federal and state requirements. Ensures adherence to regulatory requirements and organizational policies. This role is a key member of the Duals leadership team, fostering a Compliance Culture across the organization.
- Oversees the development of risk assessments and oversight and monitoring work plans pertaining DSNPs. Partners with business areas to ensure implementation of effective prevention, detection and correction of compliance issues. Prepare and present compliance reports to the Senior Leadership Team, Compliance Committees, and board highlighting compliance performance, risks and recommendations for improvement.
- Provide timely and practical information and instruction regarding new guidance from federal and state regulators ensuring that all compliance policies and procedures are reviewed annually. Review legal, regulatory, and administrative developments as necessary to address any Compliance concerns or gaps that have been identified.
- Conduct compliance reviews and manages team that conducts compliance reviews, assisting with identification of issues and collaborating with Corrections team for remediation of issues.
- Perform risk assessments and report emerging trends, deficiencies and variances, report findings to other departments and teams as appropriate.
- Oversees team responsible for monitoring against regulatory requirements; ensures sufficient monitoring activities to assist with prevention and proactive identification of compliance concerns.
- Develops and monitors metrics and other oversight tools that indicate business area compliance.
- Provides compliance guidance, direction, and compliance risk assessment to assigned business partners.
- Manages and develops direct reports who include other management or supervisory personnel and/or exempt individual contributors.
- Plans and collaborates with other teams and leaders on complex projects/programs necessitating the origination and application of new and unique approaches.
- Sets operational priorities including the development and maintenance of effective oversight activities and prioritization of work.
- Responsible for Board and Executive reporting related to responsibilities of the team and compliance of business operations for which you oversee.
- Educates, encourages, and assists those within the company to maintain integrity through correction of identified non-compliance in order to meet the requirements of Government-sponsored health care programs.
- Educates, encourages, and assists those within the company to maintain integrity through correction of identified non-compliance in order to meet the requirements of Government-sponsored health care programs.
- Participates in mock and actual CMS and other regulatory audits and coordinates with Internal Audit, Regulatory Compliance and/or Market based Regulatory Affairs on responses to agency inquiries and oversees the internal and external processes required to ensure the Company maintains a consistent state of Audit readiness.
- Maintains a current working knowledge of various laws, regulations, and industry guidance that impacts the health industry generally, and government programs in the health sector specifically, including fraud and abuse and anti-kickback statutes, OIG and government health plan guidelines and state marketing compliance laws, prompt pay, provider adequacy and other laws.
- Ensure that data, materials and other information submitted to CMS are accurate and in compliance with CMS reporting requirements.
- Performs other duties as assigned
- Complies with all policies and standards
Education/Experience: Bachelor's Degree Bachelor’s Degree in Business Administration, Healthcare Administration or related field required: Master's Degree Business Administration preferred: 7+ years Experience in health care or managed care required
5+ years Experience with dual programs (DSNPs or MMPs) required
5+ years Compliance focused solutions (HIPAA, NAIC, CMS, SOX, etc.) preferred
JD, MHA, CHC or related preferred:Pay Range: $142,300.00 - $263,500.00 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. 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
