About the role

  • Direct and oversee regulatory compliance operations to ensure fully compliance with all applicable laws and regulations for assigned products/services
  • Oversee, administer, and implement various aspects of the Medicare Compliance program, including HPMS communication/regulation
  • Ability to research and apply CMS, DOI, OIG, and HIPPA regulations to create processes and strategies while ensuring corporate compliance
  • Coordinate and document Centene responses to CMS Request for Information/Response
  • Provide guidance to various departments regarding compliance issues and ensure implementation of new compliance requirements with respect to regulatory and contract language
  • Identify, evaluate and analyze the impact of CMS and Medicare regulatory issues and advise management concerning impact
  • Partner with various departments to ensure that state and/or federal regulatory requirements are communicated and met
  • Maintain and track laws and regulations, contract documentations, amendments, and various compliance measures
  • Ensure all Medicare products and services are being tested for compliance with program regulations, insurance regulations, and regulatory requirements for business entities
  • Develop policies, procedures, and process to comply with federal program regulations, and any applicable state regulations; ensure policies and procedures are updated according to CMS/contract requirements

Requirements

  • Bachelor's degree in Business Administration, Health Care Administration, related field or equivalent experience
  • 7+ years of regulatory, compliance, operations, or related experience, preferably in a health care environment
  • Advanced degree preferred

Benefits

  • competitive pay
  • health insurance
  • 401K and stock purchase plans
  • tuition reimbursement
  • paid time off plus holidays
  • flexible approach to work with remote, hybrid, field or office work schedules

Job title

Director, Regulatory Operations

Job type

Experience level

Lead

Salary

$110,900 - $205,000 per year

Degree requirement

Bachelor's Degree

Location requirements

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