Director, Regulatory Operations

Centene; United States; Remote; USD 108,000 - 199,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Remote, hybrid, field or office work S

Job summary

Centene is seeking a Regulatory Compliance Leader to direct and oversee operations ensuring adherence to all applicable laws for Ambetter products and services. The role is fully remote and requires CMS/HIPAA expertise, with strong collaboration across departments to implement evolving regulatory requirements.

Ideal candidates will have 7+ years in regulatory/compliance within healthcare and a Bachelor's degree; advanced degrees are a plus.

Qualifications

• 7+ years of regulatory, compliance, operations, or related experience, preferably in a health care environment.
• Bachelor's degree in Business Administration, Health Care Administration, related field or equivalent experience.
• Advanced degree preferred.

Responsibilities

• Oversee, administer, and implement Ambetter Regulatory Operations programs, including regulatory complaints and grievance support.
• Research and apply CMS, DOI, OIG, and HIPAA regulations to create compliant processes and strategies.
• Coordinate Centene responses to CMS regulator requests for information and responses.
• Provide guidance to departments on compliance issues and implement new regulatory requirements.
• Identify and analyze CMS and Marketplace regulatory issues and advise management on impact.
• Partner with departments to ensure state/federal regulatory requirements are communicated and met.
• Maintain and track laws, regulations, contract documents, and compliance measures.
• Ensure Marketplace products/services are tested for regulatory compliance and insurance regulations.
• Develop policies and procedures to comply with federal/state program regulations; keep policies updated per CMS/contract requirements.

Skills

Regulatory compliance

Policy development

CMS knowledge

Cross-functional collaboration

Education

Bachelor's degree in Business Administration, Health Care Administration, related field

Advanced degree preferred

Job description

Position Purpose: Direct and oversee regulatory compliance operations to ensure fully compliance with all applicable laws and regulations for assigned products/services.

Key Details

The role is fully remote. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

Responsibilities

• Oversee, administer, and implement various aspects of the Ambetter Regulatory Operations program, including regulatory complaints, complaint escalations and grievance support.
• Ability to research and apply CMS, DOI, OIG, and HIPPA regulations to create processes and strategies while ensuring corporate compliance.
• Coordinate and document Centene responses to CMS/Regulator Request for Information/Response.
• Provide guidance to various departments regarding compliance/regulatory issues and ensure implementation of new compliance requirements with respect to regulatory and contract language.
• Identify, evaluate and analyze the impact of CMS and Marketplace 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.
• Ensure all Marketplace products and services are being tested for compliance with program regulations, insurance regulations, and regulatory requirements for business entities.
• Develop policies, procedures, and process to comply with federal program regulations, and any applicable state regulations; ensure policies and procedures are updated according to CMS/contract requirements.

Education/Experience

Bachelor's degree in Business Administration, Health Care Administration, related field or equivalent experience. 7+ years of regulatory, compliance, operations, or related experience, preferably in a health care environment Advanced degree preferred.

Pay Range

$107,700.00 - $199,300.00 per year

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.

Benefits

• 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