Senior Director, Compliance Advisory (Medicare)

Centene; United States; Remote; USD 145,000 - 269,000; Full time

Job summary

An established industry player is seeking a Compliance Manager to lead regulatory compliance initiatives for Medicare and Medicaid products. This role involves overseeing compliance programs, developing strategic relationships, and ensuring adherence to federal and state regulations. You'll collaborate with various departments, provide essential training, and represent senior management in key meetings. With the flexibility to work remotely, this position offers a chance to make a significant impact on the health of communities while enjoying competitive pay and comprehensive benefits.

Benefits

Health Insurance

401K

Stock Purchase Plans

Tuition Reimbursement

Paid Time Off

Flexible Work Arrangements

Qualifications

• 10+ years of compliance experience, preferably in healthcare.
• Experience with Medicare and/or Managed Care is essential.

Responsibilities

• Ensure regulatory compliance with federal and state requirements.
• Oversee and monitor cross-functional projects and compliance programs.

Skills

Regulatory Compliance

Medicare Regulations

Public Policy Development

Project Management

Risk Management

Education

Bachelor’s Degree in Business Administration

Master’s Degree or Juris Doctor

Tools

Compliance Software

Job description

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 Continental United States.

Position Purpose:

Ensure regulatory compliance with federal and state legal and regulatory requirements related to Medicare compliance and HPMS/CMS regulations.

1. Oversee and monitor various cross-functional projects implemented by management.
2. Develop strategic relationships to assist with the development of public policy concerning federal managed care regulations and initiatives.
3. Represent senior management at various committees, meetings, and seminars.
4. Communicate with CMS to ensure the timely completion of CMS requirements and expectations.
5. Ensure all Medicare and Medicaid products and services are tested for compliance with program regulations, insurance regulations, and regulatory requirements for business entities.
6. Maintain and track laws, regulations, contract documentation, amendments, and compliance measures.
7. Develop policies, procedures, and processes to comply with federal and state program regulations.
8. Collaborate with Operational Departments to ensure policies, procedures, and processes meet regulatory standards and provide guidance on regulatory and contractual language.
9. Oversee, administer, and implement aspects of the Medicare Compliance program.
10. Provide guidance regarding compliance issues and the implementation of new requirements related to regulatory and contract language.
11. Identify, evaluate, and analyze the impact of CMS and Medicare regulatory issues and advise management accordingly.
12. Report all Medicare and MMP risks in accordance with risk reporting policies.
13. Provide required ethics, compliance, risk management, FWA, privacy, and security training for employees and contractors as needed.
14. Partner with departments to ensure regulatory requirements are communicated and met.
15. Perform other duties as assigned.
16. Comply with all policies and standards.

Education/Experience:

1. Bachelor’s degree in Business Administration, Healthcare Administration, or a related field; Master’s Degree or Juris Doctor preferred.
2. 10+ years of compliance experience, preferably in healthcare.
3. 5+ years of experience with Medicare and/or Managed Care.
4. 1+ years overseeing the implementation of contract requirements.
5. Interaction and communication with federal and state regulatory agencies preferred.
6. Experience with Medicare, CMS regulations, and software tools 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 such as remote, hybrid, field, or office schedules. Actual pay will be based on skills, experience, education, and other factors. Total compensation may include additional incentives.

Centene is an equal opportunity employer committed to diversity. All qualified applicants will receive consideration regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics.

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