Compliance Officer

🔥 0 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $188.9k - $359.8k / year

⏰ Full Time

🟠 Senior

🔴 Lead

🚔 Compliance

👻 Ghost score 0%

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Ensure regulatory compliance with state and other government agencies related to Health Net, Centene Corporation, and its business subsidiaries • Ensure Health Net and Centene Corporate comply with state and federal program regulations, insurance regulations, regulatory requirements for business entities, and state contract requirements • Maintain and track laws and regulations, contract documentation, amendments, and compliance measures • Develop policies, procedures, and processes to comply with state law, federal law, contract requirements, and standards • Oversee, administer, and implement compliance programs, including fraud and abuse and HIPAA • Provide guidance to departments on compliance issues and new compliance requirements concerning regulatory and contract language • Conduct compliance audits and develop and implement corrective action plans • Report achievement of corrective action plans to senior management and the Board of Directors • Develop strategic relationships with state legislative policymakers • Assist with state legislative public policy concerning insurance, Managed Care Organization, Medicare, and Medicaid regulations and initiatives • Identify, evaluate, and analyze the impact of state legislative and regulatory issues • Advise management on regulatory and legislative impacts • Represent senior management at committees, meetings, and seminars • Perform other duties as assigned • Comply with all policies and standards

🎯 Requirements

• Applicants must live in the state of California • Bachelor's Degree in Public Policy, Government Affairs, Business Administration or related field required • Master's Degree or Law degree preferred • 8+ years of compliance program management and contract experience required • Extensive knowledge of state administrative code and regulations • Knowledge of state insurance laws and regulations, including managed care regulations • Experience with state and federal government agencies • Experience with accreditation bodies • Experience with participating provider agreements • Experience with HIPAA and Third Party Administration (TPA) laws • Experience with credentialing regulations and prompt pay laws • Equivalent experience acquired through applicable knowledge, duties, scope and skill reflective of the level of this position

🏖️ Benefits

• Competitive pay • Health insurance • 401K plan • 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