Remote RN Compliance Oversight Specialist

Centene Corp.; Missouri; Hybrid; USD 90,000 - 120,000; Full time

Job summary

Centene Corp. is seeking a compliance professional to participate in auditing, monitoring, and oversight of Centene and its third parties' ethics and regulatory compliance programs, focusing on government-sponsored health care program requirements.

The role emphasizes collaboration with business owners, preparing reports, and guiding corrective actions, while supporting tools and risk assessments to ensure integrity across care management, utilization management, and quality improvement

Qualifications

• Bachelor’s degree in Nursing or related field required.
• 5+ years of related experience required.

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 the development and maintenance of monitoring and auditing tools designed to evaluate internal and third party/subcontractor compliance with clinical aspects of government-sponsored health care program requirements, State Medicaid program annual work plans, and OIG and CMS work plans including but not limited to, care management utilization management, quality improvement plan management and oversight, and appeals.
• Educate, encourage, and assist those within the company and with the company’s third parties/subcontractors to maintain integrity through oversight and monitoring and in meeting the requirements of government-sponsored health care programs.
• 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 the identification and assessment of compliance risks.
• Serve as a compliance advisor to business units and third parties with specialized focus of care management, utilization management, quality improvement plan management and oversight activities, and appeals.
• Performs other duties as assigned.
• Complies with all policies and standards.

Skills

Audit experience

Regulatory compliance

Care management

Utilization management

Report writing

Education

Bachelor’s degree in Nursing or related field

Job description

Centene Corp. is seeking a compliance professional to participate in auditing, monitoring, and oversight of Centene and its third parties' ethics and regulatory compliance programs, focusing on government-sponsored health care program requirements.

The role emphasizes collaboration with business owners, preparing reports, and guiding corrective actions, while supporting tools and risk assessments to ensure integrity across care management, utilization management, and quality improvement