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

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🔥 0 minutes ago

🦌 Connecticut, Florida, +9 more states – Remote

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

💵 $87.7k - $157.8k / year

⏰ Full Time

🟠 Senior

🚔 Compliance

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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

• 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

🎯 Requirements

• 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

🏖️ 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 • Equal opportunity employer committed to diversity