Centene

Health Plan

ComplianceOfficer

$148–274k Aragón, Spain; Cataluña, Spain; Spain FULL TIME Remote Friendly
Market Sentiment
HIGH DEMAND

Neural analysis suggests this role is
optimal for Senior candidates.

The Brief

“Compliance Officer at Centene. Skills: Health plan compliance program leadership, State Medicaid program compliance, CMS Medicare compliance, Regulatory strategy and implementation, Risk assessment and mitigation. Provide strategic leadership and oversight for the health plan compliance program. Ensure accurate and timely execution and regulatory deliverables across business and operational areas”

What You'll Achieve.

Ensure accurate and timely execution and regulatory deliverables; Ensure timely submission of all applicable regulatory filings and deliverables; Hold business owners accountable for timely remediation and sustained compliance; Provide regular reporting to market and enterprise leadership regarding risks, trends and remediation activities

Industry & Context.

Health Plan
Problems you'll solve

Identify, evaluate and analyze the impact of state regulatory changes

What They're Looking For.

Must Have

Bachelor's Degree in related field, or equivalent experience required, 7+ years Compliance program management and contract experience with State Medicaid programs including internal and State audits required, 5+ years Health care regulatory agencies in development of compliance and fraud required, 5+ years Overseeing implementation of contract requirements required

Nice to Have

Master's Degree in related field preferred, 10+ years Compliance/Enterprise Risk Management preferred

What You'll Do.

Provide strategic leadership and oversight for the health plan compliance program

Ensure accurate and timely execution and regulatory deliverables across business and operational areas

and ongoing effectiveness of the market compliance program

Oversee compliance with CMS Medicare requirements

Serve as senior compliance leader and single point of contact for state interactions

Serve as senior leadership in regulatory audit activities

Collaborate to identify

and reduce compliance and business risks

Direct corrective action planning and hold business owners accountable for remediation

Provide oversight of delegated entities

and material subcontractors

Chair or support market compliance committees

and develop compliance team members

Maintain and track contract documentation

Medicaid contract amendments

and various regulatory measures

and processes comply with state regulatory standards

Provide guidance on regulatory and contract language

Develop strategic relationships with state agencies and policymakers

evaluate and analyze the impact of state regulatory changes

Represent senior management at state committees and industry forums

Maintain deep knowledge of New Jersey Medicaid and applicable state regulatory requirements

How You'll Work.

Team & Collaboration

Collaborate with Corporate Enterprise Risk Management and market leaders; Work with Operational Departments; Provide guidance to various departments; Develop strategic relationships with agencies; Represent senior management at various state committees, meetings, and industry forums

Communication Scope

Provide regular reporting to market and enterprise leadership

Full 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 job have the flexibility to work remote from home anywhere in the Continental United States, however it is highly preferred that the selected candidate resides in New Jersey.** **Position Purpose:** Provide strategic leadership and oversight for the health plan compliance program, including compliance governance, regulatory strategy, policy development, and cross-functional implementation. Ensure accurate and timely execution and regulatory deliverables across business and operational areas. * Lead the design, execution, and ongoing effectiveness of the market compliance program in alignment with enterprise standards and regulatory expectations. * Oversee compliance with CMS Medicare requirements including SNP related obligations, and ensure timely submission of all applicable regulatory filings and deliverables. * Serve as senior compliance leader and single point of contact for state interactions, compliance meetings and market level escalations. * Serve as senior leadership in all Department of Insurance, Medicaid agency, and other regulatory audit activities applicable to New Jersey market. * Collaborate with Corporate Enterprise Risk Management and market leaders to identify, assess, document, and reduce compliance and business risks. * Internal compliance auditing and monitoring activities, direct corrective action planning, and hold business owners accountable for timely remediation and sustained compliance. * Provide oversight of delegated entities, vendors, and material subcontractors, including annual oversight performance monitoring and corrective action follow up. * Chair or support market compliance committees and provide regular reporting to marke

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