Senior Compliance Oversight Auditor (Remote)

Centene Corp.; United States; Remote; USD 90,000 - 120,000; Full time

Job summary

Centene Corp. is seeking an experienced compliance and audit professional to participate in auditing, monitoring, and oversight of Centene’s and its affiliates’ ethics and regulatory compliance programs.

The role collaborates with business owners and third parties to drive remediation and maintain integrity across government-sponsored health care programs. This remote position emphasizes care management and utilization management experience, plus audit expertise, to prepare reports and drive

Qualifications

• Bachelor’s degree in Nursing or related field required.
• 5+ years of related experience required.
• RN or LPN 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 the development and maintenance of monitoring and auditing tools designed to evaluate internal and third party/subcontractor compliance with clinical requirements.
• Educate, encourage, and assist those within the company and with third parties to maintain integrity through oversight and monitoring and in meeting government-sponsored health care program requirements.
• 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 a focus on 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

Care management

Utilization management

Regulatory compliance

Collaboration

Education

Bachelor's in Nursing

Job description

Centene Corp. is seeking an experienced compliance and audit professional to participate in auditing, monitoring, and oversight of Centene’s and its affiliates’ ethics and regulatory compliance programs.

The role collaborates with business owners and third parties to drive remediation and maintain integrity across government-sponsored health care programs. This remote position emphasizes care management and utilization management experience, plus audit expertise, to prepare reports and drive