Centene
Healthcare
Director,Risk&ComplianceProcesses&Initiatives
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“Director, Risk & Compliance Processes & Initiatives at Centene. Skills: Risk and Compliance Programs, GRC processes, Governance structures, Process documentation, Data interpretation. Develops and implements strategies to ensure successful maintenance and implementation of compliance and risk programs that meet regulatory requirements for assigned products across the enterprise. Build and continuously improve governance, risk, and compliance (GRC) processes, controls, and tool capabilities”
What You'll Achieve.
Ensure data-driven insights can be derived to guide decision-making and support regulatory, audit, and operational requirements
Industry & Context.
What They're Looking For.
Must Have
Bachelor's Degree Business Administration or related or equivalent experience required, 7+ years Compliance program management and contract experience with state Medicaid, Medicare or commercial programs, including internal and state audits required
Nice to Have
Working with healthcare regulatory agencies to develop compliance and fraud prevention programs preferred, Overseeing the implementation of federal and state insurance or program requirement preferred, Utilization of various Governance, Risk, and Compliance applications preferred
What You'll Do.
Develops and implements strategies to ensure successful maintenance and implementation of compliance and risk programs that meet regulatory requirements for assigned products across the enterprise
Build and continuously improve governance
and compliance (GRC) processes
and tool capabilities
Leads the documentation of processes and controls
ensuring that methodologies
and control frameworks are clearly articulated
Oversee the review and periodic update of compliance process documentation to reflect evolving regulatory requirements and organizational priorities
Coordinates with the GRC Administration team
Compliance Systems & Reporting to translate business needs into actionable technology requirements to support compliance and risk activities
Serve as the principal liaison between business/process stakeholders
GRC Administration team
and technology teams to identify
and prioritize requirements for integrating processes and controls within the Governance
Risk & Compliance platform (Archer Evolv)
Architects and implements governance structures for the GRC application
and escalation protocols
Designs and maintains robust standards and criteria for business cases submitted to the governance committee
Develop objective evaluation rubrics
ensuring proposals for compliance and risk initiatives are rigorously assessed for business value
and strategic alignment prior to approval
Leads efforts to ensure the accuracy and currency of field values within the GRC application
Establish and direct regular evaluation procedures with business/process stakeholders to verify that all data fields are up to date
and aligned with current business and regulatory standards
Develops a framework to evaluate and interpret data outputs and reporting generated from activities recorded in the GRC tool to ensure data-driven insights can be derived to guide decision-making and support regulatory
and operational requirements
Champions other strategic initiatives as assigned supporting Risk & Compliance Programs
Performs other duties as assigned
Complies with all policies and standards
How You'll Work.
Team & Collaboration
Champions cross-functional collaboration by working closely with Risk & Compliance teams, business units, legal, IT, and operational leaders to develop, refine, and implement comprehensive compliance and risk management processes and controls, and training; Serve as the principal liaison between business/process stakeholders, GRC Administration team, and technology teams
Process & Methodology
Project management skills
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.** **Position Purpose:** Develops and implements strategies to ensure successful maintenance and implementation of compliance and risk programs that meet regulatory requirements for assigned products across the enterprise, leveraging strong collaboration, and project management skills to build and continuously improve governance, risk, and compliance (GRC) processes, controls, and tool capabilities, informed by a background in compliance and/or auditing and a person-centered approach to accomplishing goals. * Champions cross-functional collaboration by working closely with Risk & Compliance teams, business units, legal, IT, and operational leaders to develop, refine, and implement comprehensive compliance and risk management processes and controls, and training. * Leads the documentation of processes and controls, ensuring that methodologies, procedures, and control frameworks are clearly articulated, standardized, and accessible. Oversee the review and periodic update of compliance process documentation to reflect evolving regulatory requirements and organizational priorities. * Coordinates with the GRC Administration team, Compliance Systems & Reporting to translate business needs into actionable technology requirements to support compliance and risk activities. Serve as the principal liaison between business/process stakeholders, GRC Administration team, and technology teams to identify, specify, and prioritize requirements for integrating processes and controls within the Governance, Risk & Compliance platform (Archer Evolv). * Architects and implements governance st
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