Director, Regulatory Contract Management

Centene; Tacoma (WA); Remote; USD 105,000 - 196,000; Full time

Job summary

Centene is seeking a Director of Regulatory Contract Management to lead contract management efforts between the Health Plan and State Regulatory Agency. This role involves collaboration across departments, legal research, and advising on compliance with health care laws like Medicare and Medicaid. With an emphasis on regulatory operations, the position offers competitive benefits and flexibility for remote work.

Benefits

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules

Health insurance

Qualifications

• 7+ years of combined contract drafting and legal research experience.
• Knowledge of Medicare and Medicaid regulations preferred.
• Familiarity with state insurance regulations.

Responsibilities

• Manage contracts between Health Plan and State Regulatory Agency.
• Analyze and advise on health care laws and regulatory compliance.
• Coordinate legal efforts and ensure compliance implementation.

Skills

Knowledge of health care industry

Regulatory compliance analysis

Contract negotiation

Legal research

Education

Bachelor's Degree in Business Administration, Healthcare Administration or related field

Job description

Director, Regulatory Contract Management

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: Manage all contracts between Health Plan and State Regulatory Agency. Collaborate with multiple corporate entities and departments to implement regulatory requirements.

• Direct the evaluation, review, negotiations and ongoing management of product-specific contracts and amendments between Health Plan and State Regulatory Agency
• Analyze and advise management and staff regarding state and federal health care laws, including laws applicable to managed care industry, Medicare, and Medicaid plans such as licensing requirements, prompt pay, and credentialing
• File contracts and amendments with applicable parties (e.g., State Agency and Department of Insurance)
• Coordinate distribution of contracts, policy changes and the impact analyses within the company
• Perform legal research and prepare memoranda regarding legislative or regulatory changes affecting the company’s vendor and/or health care provider contracts
• Coordinate legal efforts with the Corporate Legal Department
• Develop and implement contract/policy changes and impact analyses within the plan
• Manage legal aspects of Open Records process, appeal, IRO and Fair Hearings processes between Health Plan and State Regulatory Agency
• Oversee, administer, and implement various aspects of the Medicaid Regulatory Operations/ Compliance program, including communication to/from the Medicaid Agency, Medicaid Contracts, Annual Audit, and findings from that audit
• Coordinate and document Coordinated Care's responses to Medicaid Agency Request for Information/Response
• Provide guidance to various departments regarding regulatory issues and ensure implementation of new compliance requirements with respect to regulatory and contract language
• Identify, evaluate, and analyze the impact of Medicaid and Medicare regulatory issues and advise management concerning impact
• Partner with various departments to ensure that state and/or federal regulatory requirements are communicated and met
• Maintain and track laws and regulations, contract documentations, amendments, and various compliance measures
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience: Bachelor's Degree in Business Administration, Healthcare Administration or related field. 7+ years of combined contract drafting and legal research experience. Knowledge of the health care industry, specifically government services and applicable laws and regulations. Knowledge of Medicare and/or Medicaid insurance, state insurance and HMO regulations preferred.

This position is remote within the state of Washington. In person meeting attendance required as needed.

Pay Range: $105,600.00 - $195,400.00 per year

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: Manage all contracts between Health Plan and State Regulatory Agency. Collaborate with multiple corporate entities and departments to implement regulatory requirements.

• Direct the evaluation, review, negotiations and ongoing management of product-specific contracts and amendments between Health Plan and State Regulatory Agency
• Analyze and advise management and staff regarding state and federal health care laws, including laws applicable to managed care industry, Medicare, and Medicaid plans such as licensing requirements, prompt pay, and credentialing
• File contracts and amendments with applicable parties (e.g., State Agency and Department of Insurance)
• Coordinate distribution of contracts, policy changes and the impact analyses within the company
• Perform legal research and prepare memoranda regarding legislative or regulatory changes affecting the company’s vendor and/or health care provider contracts
• Coordinate legal efforts with the Corporate Legal Department
• Develop and implement contract/policy changes and impact analyses within the plan
• Manage legal aspects of Open Records process, appeal, IRO and Fair Hearings processes between Health Plan and State Regulatory Agency
• Oversee, administer, and implement various aspects of the Medicaid Regulatory Operations/ Compliance program, including communication to/from the Medicaid Agency, Medicaid Contracts, Annual Audit, and findings from that audit
• Coordinate and document Coordinated Care's responses to Medicaid Agency Request for Information/Response
• Provide guidance to various departments regarding regulatory issues and ensure implementation of new compliance requirements with respect to regulatory and contract language
• Identify, evaluate, and analyze the impact of Medicaid and Medicare regulatory issues and advise management concerning impact
• Partner with various departments to ensure that state and/or federal regulatory requirements are communicated and met
• Maintain and track laws and regulations, contract documentations, amendments, and various compliance measures
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience: Bachelor's Degree in Business Administration, Healthcare Administration or related field. 7+ years of combined contract drafting and legal research experience. Knowledge of the health care industry, specifically government services and applicable laws and regulations. Knowledge of Medicare and/or Medicaid insurance, state insurance and HMO regulations preferred.

This position is remote within the state of Washington. In person meeting attendance required as needed.

Pay Range: $105,600.00 - $195,400.00 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

About the company

Centene Corporation is a publicly traded managed care company based in St.

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