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, however it is highly preferred that the selected candidate resides in New Jersey. Position Purpose:
Provide strategic leadership and oversight for the health plan compliance program, including compliance governance, regulatory strategy, policy development, and cross-functional implementation. Ensure accurate and timely execution and regulatory deliverables across business and operational areas.
- Lead the design, execution, and ongoing effectiveness of the market compliance program in alignment with enterprise standards and regulatory expectations.
- Oversee compliance with CMS Medicare requirements including SNP related obligations, and ensure timely submission of all applicable regulatory filings and deliverables.
- Serve as senior compliance leader and single point of contact for state interactions, compliance meetings and market level escalations.
- Serve as senior leadership in all Department of Insurance, Medicaid agency, and other regulatory audit activities applicable to New Jersey market.
- Collaborate with Corporate Enterprise Risk Management and market leaders to identify, assess, document, and reduce compliance and business risks.
- Internal compliance auditing and monitoring activities, direct corrective action planning, and hold business owners accountable for timely remediation and sustained compliance.
- Provide oversight of delegated entities, vendors, and material subcontractors, including annual oversight performance monitoring and corrective action follow up.
- Chair or support market compliance committees and provide regular reporting to market and enterprise leadership regarding risks, trends and remediation activities.
- Lead, coach, and develop compliance team members, and establish clear priorities, accountabilities and performance expectations.
- For New Jersey plan only additional responsibilities:
- Maintain and track contract documentation, Medicaid contract amendments, and various regulatory measures.
- Work with Operational Departments to ensure that policies, procedures, and processes are developed and modified to comply with state regulatory standards. Provide guidance to various departments with respect to regulatory and contract language.
- Develop strategic relationships with agencies within the New Jersey Department of Human Services and other state regulatory policymakers with oversight responsibility for Managed Care organizations, Medicare and Medicaid initiatives. Identify, evaluate and analyze the impact of state regulatory changes and advise management concerning impact.
- Represent senior management at various state committees, meetings, and industry forums and other engagements relevant to compliance and regulatory strategy.
- Maintain deep knowledge of New Jersey Medicaid and applicable state regulatory requirements. .
- Complies with all policies and standards.
Education/Experience:
- Bachelor's Degree in related field, or equivalent experience required
- Master's Degree in related field preferred
- 7+ years Compliance program management and contract experience with State Medicaid programs including internal and State audits required
- 5+ years Health care regulatory agencies in development of compliance and fraud programs; required
- 5+ years Overseeing implementation of contract requirements required
- 10+ years Compliance/Enterprise Risk Management preferred
Pay Range: $148,000.00 - $274,200.00 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
