California Compliance Officer

Centene Management Company • Woodland Hills, CA

35d • Remote

About The Position

Ensure regulatory compliance with state and other government agencies related to Health Net, Centene Corporation, and its business subsidiaries. Applicants for this role must live in the state of California. Ensure Health Net and Centene Corporate are in compliance with state and federal program regulations, insurance regulations, regulatory requirements for business entities and state contract requirements. Maintain and track laws and regulations, contract documentations, amendments, and various compliance measures. Develop policies, procedures, and processes to comply with state law, federal law, contract requirements, and various standards. Oversee, administer, and implement various compliance programs, including fraud and abuse and HIPAA. Provide guidance to various departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contract language. Conduct compliance audits, develop and implement corrective action plans, and report on achievement of action plans to senior management and Board of Directors. Develop strategic relationships with state legislative policymakers and assist with the development of state legislative public policy concerning state insurance, Managed Care Organization, Medicare and Medicaid regulations and initiatives. Identify, evaluate and analyze the impact of state legislative and regulatory issues and advise management concerning impact. Represent senior management at various committees, meetings, and seminars. Performs other duties as assigned. Comply with all policies and standards.

Requirements

• Applicants for this role must live in the state of California.
• Bachelor's Degree in Public Policy, Government Affairs, Business Administration or related field required.
• 8+ years of compliance program management and contract experience required.
• Extensive knowledge of state administrative code and regulations, state insurance laws and regulations including managed care regulations.
• Experience with state and federal government agencies, accreditation bodies, participating provider agreements, HIPAA and Third Party Administration (TPA) laws, credentialing regulations and prompt pay laws.
• Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.

Nice To Haves

• Master's Degree or Law degree preferred.

Responsibilities

• Ensure regulatory compliance with state and other government agencies related to Health Net, Centene Corporation, and its business subsidiaries.
• Ensure Health Net and Centene Corporate are in compliance with state and federal program regulations, insurance regulations, regulatory requirements for business entities and state contract requirements.
• Maintain and track laws and regulations, contract documentations, amendments, and various compliance measures.
• Develop policies, procedures, and processes to comply with state law, federal law, contract requirements, and various standards.
• Oversee, administer, and implement various compliance programs, including fraud and abuse and HIPAA.
• Provide guidance to various departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contract language.
• Conduct compliance audits, develop and implement corrective action plans, and report on achievement of action plans to senior management and Board of Directors.
• Develop strategic relationships with state legislative policymakers and assist with the development of state legislative public policy concerning state insurance, Managed Care Organization, Medicare and Medicaid regulations and initiatives.
• Identify, evaluate and analyze the impact of state legislative and regulatory issues and advise management concerning impact.
• Represent senior management at various committees, meetings, and seminars.
• Performs other duties as assigned.
• Comply with all policies and standards.

Benefits

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

What This Job Offers

• Job Type: Full-time
• Career Level: Senior