Lead Compliance Oversight

Centene Corporation; United States; Remote; USD 110,000 - 160,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible remote/hybrid/onsite work

Job summary

Centene Corporation seeks a senior compliance professional to lead and mentor the team across planning, execution, and reporting of compliance projects. You will review staff and senior specialists’ work and ensure corrective action plans are completed timely in line with state and federal requirements.

The role involves collaboration with management, in-house counsel, and external auditors, promoting awareness of the Corporate Ethics and Compliance Program, and delivering regular reports to Sr.

Qualifications

• Bachelor’s Degree in a related field; an additional 2 years of Compliance/Auditing experience may be substituted in lieu of the degree
• 5+ years of experience in Compliance/Auditing required
• 3+ years of experience in State or Federal Managed Care Programs required
• 1+ year of experience in reading, analyzing, and interpreting State and Federal laws, rules and regulations required
• Certifications in CHC/CCEP/CIA/CFE preferred

Responsibilities

• Guides and mentors department associates and staffs effectively.
• Collaborates with other departments to route compliance issues for research and resolution.
• Communicates the importance of the compliance program to health plan staff and audits.
• Maintains status of projects and deliverables with Corporate Compliance management.
• Provides independent analyses of business processes, controls, and regulatory compliance.
• Ensures monitoring and oversight testing, documentation, and reporting are completed on time to professional standards.
• Tracks internal and external corrective action plans to completion.
• Educates staff to promote integrity and compliance with State Medicaid, OIG, and CMS requirements.
• Coordinates with external auditors and supports management reporting to Sr. Management and the Board.

Skills

Mentoring

Leadership

Compliance program awareness

Project coordination

Communication with auditors

Education

Bachelor’s degree in a related field

Certified HealthCare Compliance (CHC) preferred

Certified Compliance Ethics Professional (CCEP) preferred

Certified Internal Auditor (CIA) preferred

Certified Fraud Examiner (CFE) preferred

Job description

Position Purpose: Position performs and/or leads compliance related projects and assessments from planning through reporting, reviews staff and senior compliance specialists' work, and ensures the completion of internal and external corrective action plans. In addition, serves as a subject matter expert in the department and may be a mentor to staff and/or interns.

Key Details: Applicants for this job have the flexibility to work remote from home anywhere in the Continental United States.

• Provides work guidance, direction and mentoring to department associates.
• Collaborates with other departments to direct compliance issues to appropriate channels for research and resolution. Consults with management, in-house counsel, and/or the VP of Corporate Compliance as needed to resolve difficult compliance issues.
• Communicates the importance of compliance and the compliance program to health plan staff, which includes promoting increased awareness of the Corporate Ethics and Compliance Program, understanding of new and existing compliance issues and related policies and procedures, and the importance of internal compliance audits.
• Works closely with Corporate Compliance management regarding the status of projects and assigned deliverables.
• Provides independent appraisals, analyses, and observations for examining and evaluating the adequacy and effectiveness of business processes, internal controls, and regulatory compliance.
• Ensures all monitoring and oversight testing, documentation, and reporting is completed with quality, in a timely manner, and in accordance with professional standards.
• Ensures internal and external corrective action plans are tracked to completion.
• Serves to educate, encourage and assist those within the Company to maintain integrity through oversight and monitoring and in meeting the requirements of State Medicaid Programs, OIG and CMS requirements.
• Communicates and coordinates with external auditors.
• Assists Corporate Audit & Oversight management in preparing the annual compliance risk profile and is responsible for developing and/or executing compliance monitoring and oversight work plans.
• Assists Corporate Audit & Oversight management in preparing monthly, quarterly, and annual reporting to Sr. Management and the Board of Directors.
• Performs other projects as assigned.

Education/Experience:

• A Bachelor's Degree in a related field; an additional 2 years of Compliance/Auditing experience may be substituted in lieu of the degree
• 5+ years of experience in Compliance/Auditing required
• 3+ years of experience in State or Federal Managed Care Programs required
• 1+ year of experience in reading, analyzing, and interpreting State and Federal laws, rules and regulations required

Licenses and Certifications:

• Certified in HealthCare Compliance (CHC) preferred
• Certified Compliance Ethics Professional (CCEP) preferred
• Certified Internal Auditor (CIA) preferred
• Certified Fraud Examiner (CFE) preferred

At the company, 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.

• 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.

the company 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