Medicare Compliance Advisor - Clinical Care & Quality

Centene Corporation; North Carolina; Hybrid; USD 88,000 - 158,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K

Stock purchase plan

Tuition reimbursement

Paid time off

Holidays

Flexible work arrangements

Job summary

Centene Corporation in the United States seeks an expert for the Medicare Compliance Advisory program. You will interpret CMS guidance, coordinate regulatory communications, and support audits to ensure timely, accurate deliverables. This role partners with leadership to identify risks and drive corrective actions across operations.

The position emphasizes research, documentation, and mentoring as part of ongoing compliance improvements within a large managed care environment.

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 to include regulatory research and drafting compliance guidance, assessing risk, issue tracking, auditing / monitoring, and overseeing the development and implementation of correction action plans required.
• 2+ years experience supporting managed care, Medicare Advantage/Part D, or Dual Eligible (DSNP) programs.
• Foundational knowledge of Medicare regulations, including CMS guidance and compliance expectations (e.g., Parts C & D).
• Strong written and verbal communication skills.
• Strong analytical, organizational and documentation skills with attention to detail.
• Ability to manage multiple assignments and meet deadlines in a fast-paced environment.

Responsibilities

• Execute the Medicare Compliance Program in alignment with CMS and applicable federal and state regulations, ensuring prevention, detection, and correction of noncompliance and FWA.
• Interprets and translates federal, state, and contractual requirements into clear, actionable compliance guidance for business stakeholders, ensuring consistent understanding and application across operations.
• Develops and coordinates regulatory communications, including responses to inquiries, issue summaries, and disclosures, while serving as a liaison with internal stakeholders and external regulators as appropriate.
• Supports the preparation, validation, and submission of regulatory reports, attestations, and filings, ensuring accuracy, completeness, and timeliness of all deliverables.
• Proactively identifies compliance risks and evaluates business processes to assess exposure, provide risk stratification, and recommend mitigation strategies.
• Leads or supports issue identification, root cause analysis, and development of corrective action plans to ensure effective and compliant resolution of identified gaps.
• Provides subject matter expertise to audit and monitoring activities, including supporting audit scope development, testing strategies, and ongoing compliance oversight.
• Partners with internal and external stakeholders to support audit execution, regulatory reviews, and ongoing audit readiness activities.
• Evaluates remediation plans and validates corrective actions to ensure sustainable and compliant resolution of issues, including assessment of regulatory reporting or disclosure requirements.
• Contributes to the development and delivery of compliance training, while mentoring stakeholders on regulatory requirements, policies, and best practices.
• Reviews and assesses policies, procedures, and business processes to ensure alignment with regulatory and contractual requirements and organizational standards.
• Leads or contributes to cross-functional initiatives to enhance compliance processes, drive operational efficiency, and align compliance activities with organizational objectives.
• Monitors regulatory developments and industry trends to identify emerging risks and support continuous improvement of compliance programs.
• Collaborates with compliance, legal, audit, and operational partners to ensure coordinated execution of compliance activities across business areas.
• Performs other duties as assigned.
• Complies with all policies and standards.

Skills

Regulatory research

Regulatory guidance

Issue tracking

Audit readiness

Documentation

Stakeholder communication

Policy interpretation

Analytical thinking

Education

Bachelor’s degree in a related field

Master’s degree or Juris Doctor preferred

Job description

Centene Corporation in the United States seeks an expert for the Medicare Compliance Advisory program. You will interpret CMS guidance, coordinate regulatory communications, and support audits to ensure timely, accurate deliverables. This role partners with leadership to identify risks and drive corrective actions across operations.

The position emphasizes research, documentation, and mentoring as part of ongoing compliance improvements within a large managed care environment.