Medicare Compliance Advisor - Clinical & Care Management

Centene Corporation; Connecticut; Remote; USD 88,000 - 158,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules (remote/hybrid

Job summary

Centene Corporation seeks an experienced Medicare Compliance Advisory expert to guide day-to-day activities ensuring alignment with CMS requirements and federal/state regulations. You will translate complex regulations into actionable guidance for business units and support audit readiness and monitoring programs.

The role involves collaboration with leadership, issue tracking, and development of corrective actions to reduce compliance risk while maintaining efficient operations across programs

Qualifications

• Bachelor’s degree in a related field (e.g., healthcare administration, public health, policy) or equivalent experience required.
• Master’s Degree or Juris Doctor preferred.
• 5+ years Compliance, regulatory, operations, or risk management within a regulated industry (e.g., healthcare, managed care, insurance, or public sector).
• 4+ years Compliance advisory experience, including regulatory research and drafting compliance guidance, risk assessment, issue tracking, auditing/monitoring, and corrective action plans.
• 2+ years experience supporting managed care, Medicare Advantage/Part D, or Dual Eligible (DSNP) programs.
• Foundational knowledge of Medicare regulations, CMS guidance and compliance expectations (Parts C & D).
• Related/licensure (e.g., RN, LPN, Pharmacist) preferred.

Responsibilities

• Execute the Medicare Compliance Program in alignment with CMS and applicable regulations, ensuring prevention, detection, and correction of noncompliance and FWA.
• Translate federal, state, and contractual requirements into clear, actionable compliance guidance for business stakeholders.
• Develop and coordinate regulatory communications, including responses to inquiries and disclosures, liaising with regulators as appropriate.
• Support preparation, validation, and submission of regulatory reports, attestations, and filings with accuracy and timeliness.
• Identify compliance risks and evaluate business processes to assess exposure, risk, and mitigation.
• Lead or support root cause analysis and corrective action plans for identified gaps.
• Provide SME for audit and monitoring activities, including scope development and testing strategies.
• Collaborate with stakeholders to support audits, regulatory reviews, and audit readiness.

Skills

Strong written communication

Strong verbal communication

Analytical skills

Documentation skills

Education

Bachelor's degree

Master's degree

Juris Doctor

Job description

Centene Corporation seeks an experienced Medicare Compliance Advisory expert to guide day-to-day activities ensuring alignment with CMS requirements and federal/state regulations. You will translate complex regulations into actionable guidance for business units and support audit readiness and monitoring programs.

The role involves collaboration with leadership, issue tracking, and development of corrective actions to reduce compliance risk while maintaining efficient operations across programs