Medicare Compliance Advisor - Clinical Ops & Quality

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

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Job summary

Centene Corporation seeks an expert to support the Medicare Compliance Advisory program, aligning with CMS requirements and state regulations. The role provides regulatory guidance, conducts research, tracks issues, and supports audit readiness across business areas.

You will translate complex regulations into actionable guidance for stakeholders, help prepare regulatory reports, and contribute to corrective actions, training, and ongoing compliance improvements.

Qualifications

• 5+ years in compliance, regulatory, operations, or risk management.
• 4+ years compliance advisory experience.
• Experience with regulatory research and drafting guidance.
• Experience with issue tracking, auditing, and monitoring.
• Experience supporting managed care Medicare Advantage/Part D, or DSNP programs.
• Foundational knowledge of Medicare regulations including CMS guidance.

Responsibilities

• Execute the Medicare Compliance Program per CMS and state regulations.
• Translate requirements into actionable guidance for stakeholders.
• Prepare and submit regulatory reports, attestations, and filings.
• Identify compliance risks and evaluate processes.
• Lead or support root cause analysis and corrective actions.
• Support audit scope, testing strategies, and ongoing oversight.
• Collaborate with stakeholders to support audits and regulatory reviews.
• Review policies to ensure regulatory alignment.
• Monitor regulatory developments and industry trends.

Skills

Regulatory research

Compliance advisory

Issue tracking

Risk assessment

Analytical thinking

Documentation

Communication skills

Education

Bachelor’s degree in related field

Master’s Degree or JD preferred

Job description

Centene Corporation seeks an expert to support the Medicare Compliance Advisory program, aligning with CMS requirements and state regulations. The role provides regulatory guidance, conducts research, tracks issues, and supports audit readiness across business areas.

You will translate complex regulations into actionable guidance for stakeholders, help prepare regulatory reports, and contribute to corrective actions, training, and ongoing compliance improvements.