About the role
Position Purpose: Position performs and/or leads compliance related projects and assessments from planning through reporting, reviews staff and senior compliance specialists' work, and ensures the completion of internal and external corrective action plans. In addition, serves as a subject matter expert in the department and may be a mentor to staff and/or interns.
Key Details: Applicants for this job have the flexibility to work remote from home anywhere in the Continental United States.
Provides work guidance, direction and mentoring to department associates.
Collaborates with other departments to direct compliance issues to appropriate channels for research and resolution. Consults with management, in-house counsel, and/or the VP of Corporate Compliance as needed to resolve difficult compliance issues.
Communicates the importance of compliance and the compliance program to health plan staff, which includes promoting increased awareness of the Corporate Ethics and Compliance Program, understanding of new and existing compliance issues and related policies and procedures, and the importance of internal compliance audits.
Works closely with Corporate Compliance management regarding the status of projects and assigned deliverables.
Provides independent appraisals, analyses, and observations for examining and evaluating the adequacy and effectiveness of business processes, internal controls, and regulatory compliance.
Ensures all monitoring and oversight testing, documentation, and reporting is completed with quality, in a timely manner, and in accordance with professional standards.
Ensures internal and external corrective action plans are tracked to completion.
Serves to educate, encourage and assist those within the Company to maintain integrity through oversight and monitoring and in meeting the requirements of State Medicaid Programs, OIG and CMS requirements.
Communicates and coordinates with external auditors.
Assists Corporate Audit & Oversight management in preparing the annual compliance risk profile and is responsible for developing and/or executing compliance monitoring and oversight work plans.
Assists Corporate Audit & Oversight management in preparing monthly, quarterly, and annual reporting to Sr. Management and the Board of Directors.
Performs other projects as assigned.
Education/Experience:
A Bachelor's Degree in a related field; an additional 2 years of Compliance/Auditing experience may be substituted in lieu of the degree
5+ years of experience in Compliance/Auditing required
3+ years of experience in State or Federal Managed Care Programs required
1+ year of experience in reading, analyzing, and interpreting State and Federal laws, rules and regulations required
Licenses and Certifications:
Certified in HealthCare Compliance (CHC) preferred
Certified Compliance Ethics Professional (CCEP) preferred
Certified Internal Auditor (CIA) preferred
Certified Fraud Examiner (CFE) preferred
At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
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
Originally posted on Himalayas