Job Description

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.

**Fully Remote Opportunity**

The ideal candidate will have:

• Knowledge of Dual contract requirements (e.g., Medicare-Medicaid plans)
• Experience managing external audits and communicating with regulatory agencies
• Ability to review deliverables and provide clear, actionable feedback
• Skilled in developing and maintaining audit reporting, including tracking volume, identifying risks, and analyzing trends
• Strong leadership and team management skills

Position Purpose:
Manage the Dual compliance department functions, including but not limited to, regulatory and D-SNP contract review and interpretation, periodic monitoring and auditing activities based on established compliance program, policies, and practices to ensure and maintain compliance with federal, state, and local regulatory, contractual and legal requirements.

• Manage approval and submission of timely and accurate D-SNP State Medicaid Agency (“SMAC”) contract and regulatory required report deliverables not limited to MMCM, CFR and state regulations.
• Oversee all SMAC updates including creating new and updating existing SMACs with CMS, Health Plans, States and consultants/vendors.
• Conduct periodic assessments to ensure compliance against SMAC and regulatory requirements.
• Oversee creation and implementation of corrective action plans to reduce or eliminate risk resulting from non-compliance with DSNP regulatory requirements or performance deficiencies.
• Collaborate with CMS, States, Product and Strategy, where applicable, to maintain/improve regulator satisfaction specific to member/provider experience and compliance with regulatory requirements.
• Manage composition and delivery of inquiries and responses to state regulatory agency about D-SNP inquiries. Submission may be done in collaboration with Health Plan.
• Actively engage in regulatory forums to include not limited to dedicated state meetings specific to the _DSNP. Some D-SNP meetings may be integrated with Medicaid forums. Coordinate attendance with Health Plan to ensure dedicated Duals Compliance is present.
• Support responses to “request for proposals” (RFPs) and new business implementations by completing assigned compliance tasks timely and accurately. Collaborate with Health Plan to ensure responses address where appropriate the Duals plan from Medicaid specific requirements. Ensure responses align with D-SNP federal and state requirements as well as support Duals strategy.
• Participate in new Duals business implementations, including the identification and tracking of required SMAC deliverables such as state reporting and requirements beyond D-SNP regulations or state specific program requirements applicable to the D-SNP.
• Design, implement and improve processes to prevent, detect and respond to compliance issues and concerns related to all federal and state regulatory requirements and SMAC requirements.
• Create and deliver Duals compliance training for all employees on an annual basis and as needed basis, such as in response to a compliance issue or concern.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience:

• Bachelor's Degree Health Care Administration, Compliance or related field or equivalent experience required
• 4+ years experience in compliance to include risk assessment against contract and regulatory requirements, creation and execution of auditing, monitoring and reporting processes, administration of correction action plans, implementation of written policies and procedures, developing and delivering compliance training and education required
• Experience with D-SNP SMAC, regulatory requirements and/or operations required
• Medicare managed health experience required
  

Pay Range: $86,000.00 - $154,700.00 per year

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

Job Tags

Full time, Contract work, Part time, Work at office, Local area, Remote work, Flexible hours,

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