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Policy Specialist

San Rafael, California Apply Now Job ID 1187385 Additional Locations Rancho Cordova,California,US Category Compliance Organization Envolve Schedule Full-time
Description:
Position Purpose: Maintain operational policies, procedures and workflows to ensure compliance with the state, CMS and accrediting body regulations and standards.

  • Review and make necessary updates to policies, procedures and work processes to maintain compliance with various agencies and regulations, including contract, CMS and accreditation requirements
  • Ensure all new and amended policies are operational within the assigned business units
  • Assist with the creation of readiness documents and various policies
  • Assist the Compliance department with completions of NCQA certification applications and renewals
  • Serve as a subject matter expert on business practices, policy changes, and various guidelines to assist in defining business needs
  • Monitor pending legislation and regulations affecting MHN
  • Maintain database and other reference materials related to legislative and regulatory issues and compliance.
  • Communicate state and federal requirements to internal and external clients
  • Provide development guidance and assists in the identification, implementation, and maintenance of compliance policies, procedures and work instructions.
  • Maintain and review regulatory documentation necessary to maintain corporate standards
  • Assist in developing, producing and conducting compliance training programs
  • Perform periodic compliance audits, risk assessments and conducts related ongoing compliance monitoring activities
  • Assist health plans in managing relationships with regulatory agencies and seek to resolve policy issues which may negatively impact service to members
  • Assist in audits by providing auditing material, providing explanation of policies and procedures
  • Serve as a company-wide resource and liaison on policies and workflow initiatives
Qualifications:

Education/Experience:

  • Bachelor’s degree in related field or equivalent experience.
  • 3+ years of managed care experience.
  • 1 year in health plan provider relations and/or regulatory highly preferred.
  • Experience writing and maintaining policies and procedures preferred.
  • Strong written and verbal communication skills.

    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.
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