Medicare Compliance Advisor: Clinical Care Management

Centene Corporation; Tallahassee (FL); Hybrid; USD 88,000 - 158,000; Full time

Benefits offered by this job

Health insurance

401K plan

Stock purchase plans

Tuition reimbursement

Paid time off

Job summary

Centene Corporation is seeking a Medicare Compliance Advisory expert to support day-to-day execution of the program, ensuring alignment with CMS and federal/state regulations. You will translate complex requirements into actionable guidance for business stakeholders and contribute to audit readiness.

Ideal candidates have 5+ years in compliance within regulated industries and strong communication skills. This role offers flexible work arrangements and a competitive benefits package.

Qualifications

• Bachelor's degree in a related field or equivalent experience required.
• 5+ years compliance, regulatory, operations, or risk management in a regulated industry.
• 4+ years compliance advisory experience including regulatory research, drafting guidance, risk assessment, auditing/monitoring, and corrective action plans.
• 2+ years experience supporting managed care, Medicare Advantage/Part D, or DSNP programs.
• Foundational knowledge of Medicare regulations and CMS guidance.
• Strong written and verbal communications.
• Analytical, organizational, and documentation skills with attention to detail.
• Ability to manage multiple assignments and meet deadlines in a fast-paced environment.
• CHC certification is preferred.
• Familiarity with CMS audit protocols and cross-functional environments preferred.

Responsibilities

• Execute the Medicare Compliance Program in alignment with CMS and state regulations, ensuring prevention, detection, and correction of noncompliance and FWA.
• Translate federal/state requirements into clear compliance guidance for stakeholders.
• Develop regulatory communications and liaise with regulators as appropriate.
• Prepare, validate, and submit regulatory reports, attestations, and filings.
• Identify compliance risks, evaluate processes, and recommend mitigations.
• Lead or support root-cause analysis and corrective action plans.
• Provide SME support to audit and monitoring activities.
• Collaborate with stakeholders to support audits and regulatory reviews.
• Evaluate remediation plans and validate corrective actions.
• Contribute to development and delivery of compliance training.

Skills

Regulatory guidance

Written communication

Verbal communication

Analytical

Project management

Education

Bachelor's degree in a related field

Master's Degree or JD preferred

CHC certification preferred

Job description

Centene Corporation is seeking a Medicare Compliance Advisory expert to support day-to-day execution of the program, ensuring alignment with CMS and federal/state regulations. You will translate complex requirements into actionable guidance for business stakeholders and contribute to audit readiness.

Ideal candidates have 5+ years in compliance within regulated industries and strong communication skills. This role offers flexible work arrangements and a competitive benefits package.