Manager, Compliance (Duals & D-SNP Product)

Centene; United States; 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 involves managing compliance activities, conducting audits, and collaborating with various stakeholders to enhance regulatory satisfaction. The ideal candidate will have a strong background in health care compliance and a proven track record in risk assessment and policy development. Join a dynamic team that values flexibility and offers a comprehensive benefits package, including competitive pay and remote work options, to support your professional growth and work-life balance.

Benefits

Health Insurance

401K Plan

Tuition Reimbursement

Paid Time Off

Flexible Work Arrangements

Qualifications

• 5+ years of compliance experience including risk assessment and auditing.
• Experience with D-SNP SMAC and regulatory requirements.

Responsibilities

• Manage compliance department functions and regulatory contract reviews.
• Oversee creation and implementation of corrective action plans.
• Collaborate with CMS and state agencies to maintain compliance.

Skills

Compliance Management

Risk Assessment

Auditing

Policy Development

Medicare Managed Health Experience

Education

Bachelor's Degree in Health Care Administration

Equivalent Experience

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, including 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 risk resulting from non-compliance with DSNP regulatory requirements or performance deficiencies.
5. Collaborate with CMS, States, Product, and Strategy teams to maintain or improve regulator satisfaction, focusing on member/provider experience and compliance.
6. Manage the composition and delivery of inquiries and responses to state regulatory agencies about D-SNP inquiries, in collaboration with Health Plan.
7. Actively participate in regulatory forums, including state-specific D-SNP meetings and Medicaid forums, coordinating attendance with Health Plan to ensure dedicated Duals Compliance presence.
8. Support responses to “request for proposals” (RFPs) and new business implementations by completing compliance tasks timely and accurately, ensuring responses address Medicaid-specific requirements and align with D-SNP federal and state regulations.
9. Participate in new Duals business implementations, tracking required SMAC deliverables such as state reporting and requirements beyond D-SNP regulations.
10. Design, implement, and improve processes to prevent, detect, and respond to compliance issues related to federal and state regulatory requirements and SMAC standards.
11. Create and deliver annual compliance training for all employees, with additional sessions as needed, especially in response to compliance issues.
12. Perform other duties as assigned and ensure compliance with all policies and standards.

Education/Experience:

• Bachelor's Degree in Health Care Administration, Compliance, or a related field, or equivalent experience.
• At least 5 years of compliance experience, including risk assessment, auditing, monitoring, reporting, correction action plan administration, policy development, and compliance training.
• Experience with D-SNP SMAC, regulatory requirements, and operations.
• Medicare managed health experience is required.

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

Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off and holidays, and flexible work arrangements (remote, hybrid, field, or office schedules). Actual pay will be based on skills, experience, education, and other factors permitted by law. Total compensation may include additional incentives.

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.