Senior Compliance Administrator – Clinical, SNP Model of Care, Care Management, Quality, STARs

🕒 Outubro 27

🦌 Connecticut, Florida, +9 estados a mais – Remoto

🦌 Connecticut – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🐎 Kentucky – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🏰 Missouri – Remote ⚔️ Virginia – Remote 🧀 Wisconsin – Remote

💵 $87.700 - $157.800 / ano

⏰ Tempo Integral

🟠 Sênior

🚔 Conformidade

👻 Score fantasma 0%

O que significa: a chance de ninguém estar realmente contratando para esta vaga.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Por que essa pontuação:

• Aberta há 14 dias.
• As vagas desta empresa costumam ser preenchidas em 21 dias.

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Centene Corporation

SiteLinkedInTodas as Vagas

10.000+ funcionários

Fundada em 1984

🛡️ Seguros

💼 Consultoria

🏥 Saúde

Insurance • Consulting • Healthcare

Centene Corporation é uma provedora líder de serviços de saúde patrocinados pelo governo, especializada em oferecer soluções de saúde acessíveis e de alta qualidade. Há mais de 40 anos, a Centene tem se dedicado a transformar a saúde das comunidades, ampliando o acesso a Medicaid, Medicare e ao Health Insurance Marketplace, além de atender comunidades militares por meio do programa TRICARE. Como a maior organização de managed care do Medicaid e participante-chave no Marketplace, a Centene enfatiza a entrega de cuidados de saúde com foco local, combinada a parcerias sólidas com organizações sem fins lucrativos para atender às necessidades únicas de seus membros. A Centene também é comprometida com sustentabilidade corporativa e responsabilidade social, priorizando a gestão ambiental e a governança ética para promover o bem-estar das comunidades que atende.

Descrição

• Support the day-to-day execution of the Medicare Compliance Advisory program in alignment with CMS requirements and applicable federal and state regulations • Provide regulatory guidance, conduct research and analysis, track issues, contribute to audit readiness, and support compliance workplan activities • Execute the Medicare Compliance Program to prevent, detect, and correct noncompliance and fraud, waste, and abuse (FWA) • Interpret and translate federal, state, and contractual requirements into actionable compliance guidance • Develop and coordinate regulatory communications, including inquiry responses, issue summaries, and disclosures • Support preparation, validation, and submission of regulatory reports, attestations, and filings • Identify compliance risks, assess business-process exposure, provide risk stratification, and recommend mitigation strategies • Lead or support issue identification, root cause analysis, and corrective action plans • Provide subject matter expertise for audits and monitoring activities • Support audit execution, regulatory reviews, and ongoing audit readiness • Evaluate remediation plans and validate corrective actions • Contribute to compliance training and mentor stakeholders on regulatory requirements and best practices • Review policies, procedures, and business processes for regulatory and contractual alignment • Lead or contribute to cross-functional initiatives improving compliance processes and operational efficiency • Monitor regulatory developments and industry trends to identify emerging risks • Collaborate with compliance, legal, audit, and operational partners • Perform other duties as assigned and comply with all policies and standards

🎯 Requisitos

• Bachelor’s degree in a related field (e.g., healthcare administration, public health, policy) or equivalent experience required • 5+ years Compliance, regulatory, operations, or risk management within a regulated industry • 4+ years Compliance advisory experience including regulatory research and drafting compliance guidance, assessing risk, issue tracking, auditing/monitoring, and overseeing correction action plans • 2+ years supporting managed care, Medicare Advantage/Part D, or Dual Eligible (DSNP) programs • Foundational knowledge of Medicare regulations, including CMS guidance and compliance expectations (e.g., Parts C & D) • Strong written and verbal communication skills • Strong analytical, organizational, and documentation skills with attention to detail • Ability to manage multiple assignments and meet deadlines in a fast-paced environment • Certified in Healthcare Compliance (CHC) preferred • Familiarity with CMS audit protocols, program audits, or monitoring activities preferred • Experience working in a matrixed or cross-functional environment preferred • Related/relevant licensure (e.g., RN, LPN, Pharmacist, CPhT, Case Management) preferred

🏖️ Benefícios

• Competitive pay • Health insurance • 401K • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation • Equal opportunity employer committed to diversity

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