Remote Director of Regulatory Operations

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

Benefits offered by this job

Health insurance

401K

Stock purchase plans

Tuition reimbursement

Paid time off + holidays

Flexible remote/hybrid/office

Job summary

Centene Corporation is seeking a senior regulatory compliance professional to direct Ambetter regulatory operations, ensuring all applicable CMS, HIPAA, and marketplace requirements are met across products and services. The role is fully remote and requires authorization to work in the U.S.

You will oversee complaints handling, prepare responses to regulatory requests, and advise multiple teams on policy updates and contract language.

Qualifications

• Bachelor’s degree in Business Administration, Health Care Administration, related field or equivalent experience.
• 7+ years of regulatory, compliance, operations, or related experience, preferably in health care.
• Advanced degree preferred.

Responsibilities

• Oversee, administer, and implement various aspects of the Ambetter Regulatory Operations program, including regulatory complaints, complaint escalations and grievance support.
• Research and apply 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 with respect to regulatory and contract language.
• Identify, evaluate and analyze the impact of CMS and Marketplace regulatory issues and advise management concerning impact.
• Partner with various departments to ensure that state and/or federal 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 being tested for compliance with program regulations, insurance regulations, and regulatory requirements for business entities.
• Develop policies, procedures, and process to comply with federal program regulations, and any applicable state regulations; ensure policies and procedures are updated according to CMS/contract requirements.

Skills

Regulatory compliance

CMS regulations

Regulatory documentation

Policy development

Cross-functional collaboration

Education

Bachelor’s degree or equivalent

Job description

Centene Corporation is seeking a senior regulatory compliance professional to direct Ambetter regulatory operations, ensuring all applicable CMS, HIPAA, and marketplace requirements are met across products and services. The role is fully remote and requires authorization to work in the U.S.

You will oversee complaints handling, prepare responses to regulatory requests, and advise multiple teams on policy updates and contract language.