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.
Position Purpose:
Serves as an individual contributor and subject matter expert responsible for supporting the day-to-day execution of the Medicare Compliance Advisory program in alignment with CMS requirements and applicable federal and state regulations. Provides trusted advisory support to business and compliance leadership by providing regulatory guidance, conducting research and analysis, tracking issues, contributing to audit readiness and supporting compliance workplan activities. This role partners closely with the Sr. Manager, Medicare Compliance Advisory, to ensure accurate interpretation of CMS requirements, timely completion of assignments, and consistent documentation of compliance risks, trends, and corrective actions.
- Execute the Medicare Compliance Program in alignment with CMS and applicable federal and state regulations, ensuring prevention, detection, and correction of noncompliance and FWA.
- Execute assignments, ensuring timely, accurate, and well-documented completion of deliverables.
- Serve as a compliance advisor and subject matter resource for Medicare programs by interpreting CMS regulations and guidance and translating requirements into clear, actionable business input; as well as advising leadership on compliance impact and implementation needs.
- Conduct regulatory research and analysis to support business inquiries, compliance advisory opinions, and implementation activities.
- Support intake, tracking, and resolution of compliance issues, including documenting findings, assessing risk, and recommending corrective actions.
- Contribute to monitoring and oversight activities by identifying regulatory risks and trends and supporting resolution of identified issues.
- Prepare draft responses and supporting materials for regulatory inquiries, audits, data requests, and internal compliance reviews.
- Maintain accurate and complete documentation of compliance activities, including issue logs, regulatory references, self-disclosures and supporting evidence.
- Collaborate with cross-functional business partners to clarify regulatory requirements and support the implementation of compliant processes.
- Escalate compliance risks, gaps, or delays in a timely manner to support effective risk management and decision-making.
- Contribute to audit readiness by supporting documentation, process validation, and issue resolution activities.
- Identify process improvement opportunities and support initiatives to enhance compliance controls, standardization, and operational efficiency.
- Support compliance training and education initiatives, ensuring awareness of Medicare regulatory program requirements, standards of conduct, and reporting obligations.
- Performs other duties as assigned.
- Comply with all policies and standards.
Education/Experience:
- Bachelor’s degree in a related field (e.g., healthcare administration, public health, policy) or equivalent experience required. Master's Degree or Juris Doctor preferred.
- 5+ years Compliance, regulatory, operations, or risk management within a regulated industry (e.g., healthcare, managed care, insurance, or public sector).
- Demonstrated experience interpreting and applying complex regulatory frameworks and compliance program requirements within a regulated environment into clear, actionable guidance for business stakeholders required.
- Experience leading cross-functional initiatives or large-scale compliance efforts, required.
- Experience conducting risk assessments, analyzing data, and applying structured problem-solving approaches to identify compliance risks and recommend mitigation strategies required.
- Experience effectively communicating with and managing relationships across stakeholders, including presenting complex compliance concepts to diverse audiences required.
- Demonstrated experience influencing cross-functional partners and driving outcomes in a matrixed environment without direct authority required.
- Experience 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).
- 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.
Licenses/Certifications:
- Certified in Healthcare Compliance (CHC) preferred.
- RN, LPN, Pharmacist, CPhT, Case Management preferred.
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
