Senior Director, Auditing, Monitoring & Oversight (Medicare)

Centene Corporation; Georgia (VT); Remote; USD 145,000 - 269,000; Full time

Job summary

An established industry player is seeking a Senior Director to lead compliance efforts for Medicare operations. This pivotal role involves strategic oversight, guiding various business departments, and ensuring adherence to regulatory requirements. With a focus on risk assessments and compliance reviews, you will collaborate with teams to address issues proactively. The position offers the flexibility to work remotely across the United States, along with competitive compensation and comprehensive benefits. If you are passionate about compliance in the healthcare sector and have a track record of leadership, this opportunity could be your next career milestone.

Benefits

Health Insurance

401K

Stock Purchase Plans

Tuition Reimbursement

Paid Time Off

Holidays

Flexible Work Arrangements

Qualifications

• 10+ years of compliance experience in managed care or health insurance.
• Bachelor's degree or equivalent experience required.

Responsibilities

• Oversee compliance with Medicare regulations and laws.
• Conduct compliance reviews and manage a team for issue identification.
• Develop and monitor metrics for business area compliance.

Skills

Compliance Management

Risk Assessment

Regulatory Knowledge

Team Leadership

Project Management

Education

Bachelor's Degree in Business Administration

CPA or equivalent

MHA or MBA

Job description

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You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Applicants for this role will have the flexibility to work remotely anywhere in the United States.

Position Purpose

Provides strategic leadership and management of department overseeing compliance with regulations and laws related to Medicare line of business, which includes implementation of elements of an effective compliance program related to specific operational areas. Oversee the development of risk assessments and oversight and monitoring work plans pertaining to those areas. Partners with business areas to ensure effective prevention, detection and correction of compliance issues.

Key Responsibilities

1. Establish a process for overseeing compliance with regulations and laws related to Medicare requirements.
2. Provide guidance to various business departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contractual language.
3. Conduct compliance reviews and manage team that conducts compliance reviews, assisting with identification of issues and collaborating with Corrections team for remediation of issues.
4. Perform risk assessments and report emerging trends, deficiencies and variances, report findings to other departments and teams as appropriate.
5. Oversee team responsible for monitoring against regulatory requirements ensuring sufficient monitoring activities to assist with prevention and proactive identification of compliance concerns.
6. Develop and monitor metrics and other oversight tools that indicate business area compliance.
7. Provide compliance guidance, direction and risk assessment to assigned business partners.
8. Manage and develop direct reports including management or supervisory personnel and/or exempt individual contributors.
9. Plan and collaborate on complex projects/programs requiring innovative approaches.
10. Set operational priorities including development and maintenance of oversight activities and work prioritization.
11. Report to Board and Executives on team responsibilities and compliance status of business operations.
12. Educate and assist staff in maintaining integrity through correction of non-compliance issues.
13. Participate in regulatory audits and coordinate responses to agency inquiries, ensuring audit readiness.
14. Maintain current knowledge of applicable laws, regulations, and industry guidance affecting healthcare and government programs.
15. Make decisions on complex technical issues for project components.
16. Perform additional duties as assigned.
17. Ensure compliance with all policies and standards.

Education/Experience

• Bachelor's Degree in Business Administration, Public Policy, Public Health, Health Administration, or related field; or equivalent experience.
• Preferred: CPA, CISA, JD, MHA, MBA, MIS.
• Minimum 10+ years compliance experience in managed care or health insurance.
• Management experience preferred.

Licenses/Certifications

• HCCA certification (CHC) or equivalent preferred.

Pay Range: $145,100.00 - $268,800.00 per year.

Centene offers comprehensive benefits including competitive pay, health insurance, 401K, stock purchase plans, tuition reimbursement, paid time off, holidays, and flexible work arrangements. Actual pay will be based on skills, experience, education, and other factors. Total compensation may include incentives.

Centene is an equal opportunity employer committed to diversity. All qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics.