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.Position Purpose: Provides strategic leadership and management of Compliance Corrections department which includes intake, triage, remediation and reporting activities to ensure successful resolution of identified non-compliance with Medicaid, Medicare, Marketplace, and Commercial regulatory requirements, contractual obligations and Company policies and procedures. Oversees the internal and external corrective action plan lifecycle and related reporting. Partners with Product Compliance teams, Shared Services leadership, and Health Plan leaders to ensure successful and timely remediation of identified compliance issues.
Oversees the remediation of compliance issues across all Centene lines of business.
Facilitates collaboration between compliance and business stakeholders to ensure timely completion of corrective action plans as well as escalation of issues with identified barriers to remediation.
Assists in the development of Board and Sr. Management reporting of key metrics and activities of the Corrections team.
Coordinates the oversight of corrective action plans for remediation of internally and externally identified deficiencies and ensures that remediation activities are effective and timely executed.
Develops and maintains corrections definitions, processes and tools designed to effectively remediate compliance issues in a timely manner, ensure timely escalation and sustainable resolution, and sets strategic direction for sharing with stakeholders and socializing program and process changes in collaboration with the Vice President, Compliance Guidance & Governance.
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 corrections processes and oversight of remediation plans plans based upon defined risk criteria.
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 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 CMS Program Audit readiness, including but not limited to universes, mock webinars, collaboration with internal subject matter experts (Regulatory Compliance and Internal Audit).
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.
Performs other duties as assigned.
Complies with all policies and standards.
Education/Experience:Bachelor's Degree Business Administration, Public Policy, Public Health, or Health Administration or related field, or equivalent experience requiredMaster's Degree Business Administration, Public Policy, Public Health, or Health Administration or related field preferred6+ years experience in compliance for a managed care or health insurance company required4+ years management experience preferredHCCA certification (CHC) or equivalent preferredPay Range: $113,800.00 - $210,500.00 per yearCentene 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.
