Director, Regulatory Operations

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

Job summary

Centene Corp. is seeking a Director of Regulatory Operations to lead and oversee comprehensive regulatory compliance across Ambetter programs.

This role is fully remote within the United States, requiring extensive experience in healthcare regulatory affairs and the ability to coordinate responses to CMS requests. The ideal candidate has 7+ years in regulatory/compliance/operations, with a Bachelor's in a related field and advanced degree preferred.

Qualifications

• Bachelor's degree or equivalent experience in a related field.
• 7+ years of regulatory, compliance, or operations experience in healthcare preferred.
• Advanced degree is a plus.

Responsibilities

• Direct and oversee regulatory compliance operations for assigned products and services.
• Oversee and implement Ambetter Regulatory Operations program elements, including complaints escalations.
• Research and apply CMS, DOI, OIG, and HIPAA regulations to create compliant processes.
• Coordinate and document CMS/regulator responses (RFI/Response).
• Guide departments to meet regulatory requirements and implement new compliance rules.
• Maintain and track laws, regulations and contract documentation; update policies per CMS requirements.

Skills

Regulatory compliance

Regulatory research

Operations management

Education

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

Job description

## Director, Regulatory OperationsApply: Remote-MO: Remote-TN: Remote-NM: Remote-OH: Remote-MI: Full time: Posted Today: 1664422**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.* * 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