Compliance Oversight Specialist (Non Clinical)

Centene Corporation; Missouri; Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work arrangements

Job summary

Centene Corporation seeks a Compliance Oversight professional to participate in the governance of corporate ethics and regulatory compliance for WellCare and delegated subcontractors. You will review, monitor, and assess compliance with contracts and government program requirements, driving remediation with business owners and partners.

Responsibilities include evaluating risk, producing detailed reports, and supporting corrective action plans across local markets and corporate Shared Services.

Qualifications

• 3+ years of experience in Managed Care/Health Insurance.
• Preferred 1+ year in project oversight roles with ability to drive implementation.
• Preferred 1+ year reading, analyzing, and interpreting State and Federal laws, rules and regulations.
• Preferred 1+ year State Medicaid or Federal managed care compliance.

Responsibilities

• Oversee compliance program activities and monitoring for WellCare and delegated subcontractors.
• Collaborate with business owners and vendors to drive remediation and ensure contract/regulatory requirements are met.
• Assess new/ amended Government-sponsored health care program contracts and requirements.
• Evaluate effectiveness of compliance programs and procedures,
• Prepare formal written reports with evidence and recommendations.
• Coordinate with other departments to route compliance issues for resolution.

Skills

Managed Care/Health Insurance

Project Oversight

Legal/Regulatory interpretation

Medicaid/Managed Care compliance

Education

Bachelor's degree in related field

Associates degree with 4 years experience

HS/GED with 5 years experience

Job description

Position Purpose:

Participates in the oversight of WellCare's and/or its delegated subcontractor's corporate ethics and compliance program, and ongoing oversight and analysis of regulatory compliance issues. Responsibilities include conducting focused reviews and audit, oversight, and monitoring of activities to assess compliance with WellCare's contractual and regulatory requirements; collaborates with business owners and/or delegated vendors to drive remediation and assist WellCare and delegated subcontractors to maintain integrity through oversight and monitoring and in meeting Government-sponsored health care program requirements.

• Collaborates with and assist those within the Company and the Company’s delegated subcontractors to maintain integrity through oversight and monitoring and in meeting the requirements of our executed contracts with Government-sponsored health care programs.
• Assists in the assessment of new and amended Government-sponsored health care program contracts and requirements.
• Assists Markets (local), Shared Services (corporate), and/or delegated subcontracts in the identification and assessment of compliance risks.
• Evaluates the effectiveness of Market (local), Shared Services (corporate), and/or delegated subcontractor compliance programs and related policies and procedures designed to promote legal and ethical compliance.
• Prepares accurate and timely formal written reports on oversight and monitoring activity findings and recommendations and ensure workpapers are properly prepared in accordance with WellCare and departmental standards, including sufficient evidentiary material exists to support oversight and monitoring activity findings.
• Collaborates with other departments and/or delegated subcontractors to direct compliance issues to appropriate channels for research and resolution.
• Reviews and evaluates the status and effectiveness of corrective action plans and provide comprehensive follow up to stakeholders, Senior Management, Market Compliance Oversight Committees, and/or the Audit, Finance, and Regulatory Compliance Committee of the Board of Directors.
• Participates in special projects as needed, including training.
• Performs other duties as assigned.
• Complies with all policies and standards

Education/Experience:

• A Bachelor's Degree in Related field, or Associates with 4 years of applicable experience, or HSD/GED with 5 years of applicable experience in lieu of Bachelor’s degree required
• Required 3+ years of experience in Managed Care/Health Insurance
• Preferred 1+ year of experience in project oversight type role with demonstrated ability to drive implementation and influence others
• Preferred 1+ year of experience in reading, analyzing, and interpreting State and Federal laws, rules and regulations
• Preferred 1+ year of experience in State Medicaid or Federal managed care compliance

Licenses and Certifications:

Certified in HealthCare Compliance (CHC) preferred

Pay Range: $56,200.00 - $101,000.00 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
• 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