Manager, Compliance (Duals & D-SNP Product)

Cenetene Corporation; Raleigh (NC); Remote; USD 86,000 - 155,000; Full time

Job summary

An established industry player is seeking a Compliance Manager to oversee regulatory functions and ensure adherence to D-SNP requirements. This role offers the opportunity to make a significant impact on compliance processes and member satisfaction. The ideal candidate will have extensive experience in compliance management, risk assessment, and regulatory operations, contributing to a culture of continuous improvement. Enjoy the flexibility of remote work while being part of a dynamic team dedicated to transforming healthcare for millions. Join us and be a part of this exciting journey!

Benefits

Health Insurance

401K

Stock Purchase Plans

Tuition Reimbursement

Paid Time Off

Flexible Work Arrangements

Qualifications

• 5+ years of compliance experience with a focus on D-SNP regulations.
• Experience in auditing, monitoring, and risk assessment.

Responsibilities

• Manage compliance functions for D-SNP contracts and regulatory requirements.
• Oversee corrective action plans and compliance training for employees.

Skills

Compliance Management

Risk Assessment

Auditing

Policy Development

Training

Education

Bachelor's Degree in Healthcare Administration

Compliance Certification

Job description

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.

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

Position Purpose:

Manage the Dual compliance department functions, including but not limited to, regulatory and D-SNP contract review and interpretation, periodic monitoring and auditing activities based on established compliance program, policies, and practices to ensure and maintain compliance with federal, state, and local regulatory, contractual, and legal requirements.

1. Manage approval and submission of timely and accurate D-SNP State Medicaid Agency (“SMAC”) contract and regulatory required report deliverables, not limited to MMCM, CFR, and state regulations.
2. Oversee all SMAC updates, including creating new and updating existing SMACs with CMS, health plans, states, and consultants/vendors.
3. Conduct periodic assessments to ensure compliance against SMAC and regulatory requirements.
4. Oversee creation and implementation of corrective action plans to reduce or eliminate risks resulting from non-compliance with D-SNP regulatory requirements or performance deficiencies.
5. Collaborate with CMS, states, product, and strategy teams to maintain/improve regulator satisfaction, focusing on member/provider experience and compliance.
6. Manage the creation and delivery of inquiries and responses to state regulatory agencies about D-SNP inquiries, in collaboration with health plans.
7. Actively participate in regulatory forums, including state-specific D-SNP meetings, and coordinate attendance with health plans to ensure dedicated Duals compliance representation.
8. Support responses to RFPs and new business implementations by completing compliance tasks timely and accurately, aligning responses with federal and state D-SNP requirements and duals strategies.
9. Participate in new Duals business implementations, tracking required SMAC deliverables such as state reporting and other program requirements.
10. Design, implement, and improve processes to prevent, detect, and respond to compliance issues related to federal, state, and SMAC requirements.
11. Create and deliver annual and ad-hoc compliance training for all employees.
12. Perform other duties as assigned and ensure compliance with all policies and standards.

Education/Experience:

• Bachelor's Degree in Healthcare Administration, Compliance, or related field, or equivalent experience.
• 5+ years of compliance experience, including risk assessment, auditing, monitoring, reporting, policy development, and training.
• Experience with D-SNP SMAC, regulatory requirements, and operations.
• Medicare managed health experience required.

Pay Range: $86,000.00 - $154,700.00 per year

Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K, stock purchase plans, tuition reimbursement, paid time off, holidays, and flexible work arrangements (remote, hybrid, field, or office).

Centene is an equal opportunity employer committed to diversity. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics. Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws.