Director, Regulatory Operations

Job not on LinkedIn

🔥 2 minutes ago

🐊 Florida, Kentucky, +8 more states – Remote

🐊 Florida – Remote 🐎 Kentucky – Remote 🎰 Nevada – Remote 🌶️ New Mexico – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🚗 Michigan – Remote 🏰 Missouri – Remote 🎸 Tennessee – Remote

💵 $107.7k - $199.3k / year

⏰ Full Time

🔴 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

• Direct and oversee regulatory compliance operations for assigned products/services • Oversee, administer, and implement the Ambetter Regulatory Operations program • Manage regulatory complaints, complaint escalations, and grievance support • Create processes and strategies supporting corporate compliance • Coordinate and document Centene responses to CMS/regulator requests for information or response • Provide guidance to departments on compliance and regulatory issues • Ensure implementation of new compliance requirements related to regulatory and contract language • Identify, evaluate, and analyze the impact of CMS and Marketplace regulatory issues • Advise management on regulatory impacts • Partner with departments to communicate and meet state and federal regulatory requirements • Maintain and track laws, regulations, contract documentation, amendments, and compliance measures • Ensure Marketplace products and services are tested for regulatory compliance • Develop and update policies, procedures, and processes according to CMS and contract requirements

🎯 Requirements

• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future • Bachelor's degree in Business Administration, Health Care Administration, related field or equivalent experience • 7+ years of regulatory, compliance, operations, or related experience • Experience preferably in a health care environment • Advanced degree preferred • Ability to research and apply CMS, DOI, OIG, and HIPPA regulations • Knowledge of federal program regulations and applicable state regulations • Knowledge of regulatory and contract language • Ability to develop compliant policies, procedures, and processes

🏖️ Benefits

• 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