Remote Director of Regulatory Compliance

Centene Corporation; North Carolina; Remote; USD 108,000 - 199,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Flexible remote/hybrid/field or office

Job summary

Centene Corporation in the United States is seeking a senior Regulatory Compliance leader to Direct and oversee regulatory operations for Ambetter products and services. This fully remote role requires deep expertise in CMS, HIPAA, and state/federal regulations to drive compliant processes and responses.

The role partners with multiple departments, develops policy, and ensures ongoing adherence to regulatory requirements, with a strong emphasis on quality, risk management, and effective

Qualifications

• Bachelor's degree in Business Administration, Health Care Administration, or related field; 7+ years of regulatory, compliance, operations, or related experience.
• Advanced degree preferred.
• Experience in a health care environment preferred.

Responsibilities

• Oversee, administer, and implement Ambetter Regulatory Operations program, including regulatory complaints, complaint escalations and grievance support.
• Research CMS, DOI, OIG, and HIPAA regulations to create processes and strategies while ensuring corporate compliance.
• Coordinate and document Centene responses to CMS/Regulator Request for Information/Response.
• Provide guidance to various departments regarding compliance/regulatory issues and ensure implementation of new compliance requirements.
• Identify, evaluate and analyze CMS and Marketplace regulatory issues and advise management concerning impact.
• Partner with various departments to ensure regulatory requirements are communicated and met.
• Maintain and track laws and regulations, contract documentations, amendments, and various compliance measures.
• Ensure all Marketplace products and services are tested for compliance with program regulations, insurance regulations, and regulatory requirements.
• Develop policies, procedures, and processes to comply with federal program regulations and applicable state regulations; update according to CMS/contract requirements.

Skills

Regulatory compliance

Healthcare operations

Policy development

Education

Bachelor's degree in Business Administration, Health Care Administration, related field or equivalent experience

Advanced degree preferred

Job description

Centene Corporation in the United States is seeking a senior Regulatory Compliance leader to Direct and oversee regulatory operations for Ambetter products and services. This fully remote role requires deep expertise in CMS, HIPAA, and state/federal regulations to drive compliant processes and responses.

The role partners with multiple departments, develops policy, and ensures ongoing adherence to regulatory requirements, with a strong emphasis on quality, risk management, and effective