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Compl Oversight Specialist - Non-Clinical

  • Business Area: Legal & Compliance
  • Job Type: Full time
  • Date Posted:
  • Job Number: 1467699
This job is available in 2 locations

Compl Oversight Specialist - Non-Clinical

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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.

Position Purpose: Participates in the oversight of WellCare's and/or its delegated subcontractor's corporate ethics and compliance program, and ongoing oversight and analysis of regulatory compliance issues. Responsibilities include conducting focused reviews and audit, oversight, and monitoring of activities to assess compliance with WellCare's contractual and regulatory requirements; collaborates with business owners and/or delegated vendors to drive remediation and assist WellCare and delegated subcontractors to maintain integrity through oversight and monitoring and in meeting Government-sponsored health care program requirements.
  • Collaborates with and assist those within the Company and the Company’s delegated subcontractors to maintain integrity through oversight and monitoring and in meeting the requirements of our executed contracts with Government-sponsored health care programs.

  • Assists in the assessment of new and amended Government-sponsored health care program contracts and requirements.

  • Assists Markets (local), Shared Services (corporate), and/or delegated subcontracts in the identification and assessment of compliance risks.

  • Evaluates the effectiveness of Market (local), Shared Services (corporate), and/or delegated subcontractor compliance programs and related policies and procedures designed to promote legal and ethical compliance.

  • Prepares accurate and timely formal written reports on oversight and monitoring activity findings and recommendations and ensure workpapers are properly prepared in accordance with WellCare and departmental standards, including sufficient evidentiary material exists to support oversight and monitoring activity findings.

  • Collaborates with other departments and/or delegated subcontractors to direct compliance issues to appropriate channels for research and resolution.

  • Reviews and evaluates the status and effectiveness of corrective action plans and provide comprehensive follow up to stakeholders, Senior Management, Market Compliance Oversight Committees, and/or the Audit, Finance, and Regulatory Compliance Committee of the Board of Directors.

  • Participates in special projects as needed, including training.

  • Performs other duties as assigned.
  • Performs other duties as assigned

  • Complies with all policies and standards
Required A Bachelor's Degree in Related field:
Required Other Associates with 4 years of applicable experience, or HSD/GED with 5 years of applicable experience in lieu of Bachelor’s degreeCandidate Experience: Required 3+ years of experience in Managed Care/Health Insurance
Preferred 1+ year of experience in project oversight type role with demonstrated ability to drive implementation and influence others
Preferred 1+ year of experience in reading, analyzing, and interpreting State and Federal laws, rules and regulations
Preferred 1+ year of experience in State Medicaid or Federal managed care compliance

Licenses and Certifications: A license in one of the following is required: Preferred Other Certified in HealthCare Compliance (CHC)

Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

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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