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
• Proven ability to collaborate effectively with cross-functional teams to drive audit readiness and continuous improvement

Position Purpose:
Partners with leadership in maintaining Centene Corporation's Compliance with Duals (D-SNP) Program requirements. Provide regulatory interpretation, perform compliance reporting, lead special projects, and develop and implement compliance auditing and monitoring strategies for the D-SNPs.

• Responds to external requests for information required by the organization for its Duals and SMAC regulatory filings.
• Manages Duals (and Medicare with D-DSNP specific or separate) compliance reporting responsibilities and respond to inquiries from state and federal regulatory agencies.
• Leads Duals compliance projects or implementations.
• Reviews and synthesizes Duals regulatory requirements and create policy and/or position statements.
• Partners with leadership to manage annual SMAC assessment and tracking of caps.
• Communicate Duals (state and federal) requirements to internal and external clients.
• Provides development guidance and leads the identification, implementation, and maintenance of Duals and overlapping Medicare compliance policies, procedures and work instructions.
• Leads the identification, analysis, and resolution of Duals compliance issues.
• Maintains and reviews D-SNP regulatory documentation necessary to maintain corporate standards.
• Partners with leadership in developing, producing and conducting Duals compliance training programs.
• Perform periodic compliance audits, risk assessments and conducts related to ongoing Duals compliance monitoring activities.
• Partners with Duals Manager and health plans in managing relationships with regulatory agencies and seek to confirmation and clarification of D-SNP requirements and implementations where needed.
• Performs interim Duals Compliance manager responsibilities to include supporting the health plan compliance officer with D-SNP specific responsibilities. Serve as a company-wide resource and liaison on policies, contract issues and provisions, communications, workflow, and quality improvements initiatives.
• Serves as a company-wide resource and liaison on Duals policies, SMAC items and provisions, communications, workflow, and quality improvements initiatives.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience:

• Bachelor's Degree Law or related field; or, equivalent experience required
• 4+ years Compliance and/or regulatory affairs required
• Experience in project management with working knowledge of laws and/or regulations in area of compliance, in particular Medicare, D-SNP, and state regulations required

Pay Range: $68,700.00 - $123,700.00 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, Interim role, Work at office, Remote work, Flexible hours,

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