Senior Compliance Oversight Specialist (RN)

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

Position Purpose Participate in the auditing, monitoring, and oversight of Centene's, its subsidiaries, and/or its third parties /subcontractors' corporate ethics and compliance program, and ongoing oversight and analysis of regulatory compliance issues. Conducts audit, oversight, and monitoring activities to assess compliance with aspects of Centene's contractual and regulatory requirements. Responsible for collaborating with business owners and/or third parties/subcontractors to drive remediation and assist Centene and third parties/subcontractors to maintain integrity through audit, oversight and monitoring and in meeting Government-sponsored health care program requirements.

Position Purpose Participate in the auditing, monitoring, and oversight of Centene's, its subsidiaries, and/or its third parties /subcontractors' corporate ethics and compliance program, and ongoing oversight and analysis of regulatory compliance issues. Conducts audit, oversight, and monitoring activities to assess compliance with aspects of Centene's contractual and regulatory requirements. Responsible for collaborating with business owners and/or third parties/subcontractors to drive remediation and assist Centene and third parties/subcontractors to maintain integrity through audit, overhead and monitoring and in meeting Government-sponsored health care program requirements.

Key Details:

This is a remote position. Previous experience in Care Management and/or Utilization Management, as well as audit experience, is preferred.

• 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.

Education/Experience

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

License/Certification:

RN or LPN required. Certified in HealthCare Compliance (CHC), Certified Compliance & Ethics Professional (CCEP); Certified Internal Auditor (CIA); or Certified Fraud Examiner (CFE) preferred.

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act