Remote RN Compliance Oversight Specialist

Centene Corporation; Missouri; Remote; USD 90,000 - 130,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Remote/hybrid/field or office work

Job summary

Centene Corporation is seeking a compliance-focused professional to audit, monitor, and oversee corporate ethics and regulatory requirements across Centene and its partners. This remote role emphasizes collaboration with business units and third parties to drive remediation and ensure adherence to government-sponsored health care program requirements.

The position requires a nursing degree, RN/LPN licensure, and 5+ years of related experience, with preferred CHC/CCEP/CIA/CFE certifications.

Qualifications

• RN or LPN required.
• 5+ years of related experience required.
• Certified in HealthCare Compliance (CHC), Certified Compliance & Ethics Professional (CCEP); Certified Internal Auditor (CIA); or Certified Fraud Examiner (CFE) preferred.

Responsibilities

• Prepare written reports on audit, oversight and monitoring activity findings and recommendations.
• Collaborate to direct compliance issues to appropriate channels for research and resolution.
• Review and evaluate the status and effectiveness of corrective action plans and provide comprehensive follow up.
• Support management in developing and maintaining monitoring and auditing tools designed to evaluate internal and third party/subcontractor compliance with clinical government-sponsored health care program requirements.
• Educate, encourage, and assist company and third parties to maintain integrity through oversight and monitoring.
• Assist in the assessment of new and amended government-sponsored health care program contracts and requirements.
• Assist Health Plans, Subsidiaries, Shared Services, and Third Parties/Subcontractors in identifying and assessing compliance risks.
• Serve as a compliance advisor to business units and third parties with focus on care management, utilization management, quality improvement plan management and oversight and appeals.
• Performs other duties as assigned.
• Complies with all policies and standards.

Skills

Care management

Utilization management

Auditing

Compliance

Quality improvement

Education

Bachelor's degree in Nursing or related field

Job description

Centene Corporation is seeking a compliance-focused professional to audit, monitor, and oversee corporate ethics and regulatory requirements across Centene and its partners. This remote role emphasizes collaboration with business units and third parties to drive remediation and ensure adherence to government-sponsored health care program requirements.

The position requires a nursing degree, RN/LPN licensure, and 5+ years of related experience, with preferred CHC/CCEP/CIA/CFE certifications.