Compliance Officer

Centene Corporation•Remote-NJ, NJ

2d•Remote

About The Position

Provide strategic leadership and oversight for the health plan compliance program, including compliance governance, regulatory strategy, policy development, and cross-functional implementation. Ensure accurate and timely execution and regulatory deliverables across business and operational areas. Lead the design, execution, and ongoing effectiveness of the market compliance program in alignment with enterprise standards and regulatory expectations. Oversee compliance with CMS Medicare requirements including SNP related obligations, and ensure timely submission of all applicable regulatory filings and deliverables. Serve as senior compliance leader and single point of contact for state interactions, compliance meetings and market level escalations. Serve as senior leadership in all Department of Insurance, Medicaid agency, and other regulatory audit activities applicable to New Jersey market. Collaborate with Corporate Enterprise Risk Management and market leaders to identify, assess, document, and reduce compliance and business risks. Internal compliance auditing and monitoring activities, direct corrective action planning, and hold business owners accountable for timely remediation and sustained compliance. Provide oversight of delegated entities, vendors, and material subcontractors, including annual oversight performance monitoring and corrective action follow up. Chair or support market compliance committees and provide regular reporting to market and enterprise leadership regarding risks, trends and remediation activities. Lead, coach, and develop compliance team members, and establish clear priorities, accountabilities and performance expectations. For New Jersey plan only additional responsibilities: Maintain and track contract documentation, Medicaid contract amendments, and various regulatory measures. Work with Operational Departments to ensure that policies, procedures, and processes are developed and modified to comply with state regulatory standards. Provide guidance to various departments with respect to regulatory and contract language. Develop strategic relationships with agencies within the New Jersey Department of Human Services and other state regulatory policymakers with oversight responsibility for Managed Care organizations, Medicare and Medicaid initiatives. Identify, evaluate and analyze the impact of state regulatory changes and advise management concerning impact. Represent senior management at various state committees, meetings, and industry forums and other engagements relevant to compliance and regulatory strategy. Maintain deep knowledge of New Jersey Medicaid and applicable state regulatory requirements. . Complies with all policies and standards.

Requirements

Bachelor's Degree in related field, or equivalent experience required
7+ years Compliance program management and contract experience with State Medicaid programs including internal and State audits required
5+ years Health care regulatory agencies in development of compliance and fraud programs; required
5+ years Overseeing implementation of contract requirements required

Nice To Haves

Master's Degree in related field preferred
10+ years Compliance/Enterprise Risk Management preferred

Responsibilities

Provide strategic leadership and oversight for the health plan compliance program, including compliance governance, regulatory strategy, policy development, and cross-functional implementation.
Ensure accurate and timely execution and regulatory deliverables across business and operational areas.
Lead the design, execution, and ongoing effectiveness of the market compliance program in alignment with enterprise standards and regulatory expectations.
Oversee compliance with CMS Medicare requirements including SNP related obligations, and ensure timely submission of all applicable regulatory filings and deliverables.
Serve as senior compliance leader and single point of contact for state interactions, compliance meetings and market level escalations.
Serve as senior leadership in all Department of Insurance, Medicaid agency, and other regulatory audit activities applicable to New Jersey market.
Collaborate with Corporate Enterprise Risk Management and market leaders to identify, assess, document, and reduce compliance and business risks.
Internal compliance auditing and monitoring activities, direct corrective action planning, and hold business owners accountable for timely remediation and sustained compliance.
Provide oversight of delegated entities, vendors, and material subcontractors, including annual oversight performance monitoring and corrective action follow up.
Chair or support market compliance committees and provide regular reporting to market and enterprise leadership regarding risks, trends and remediation activities.
Lead, coach, and develop compliance team members, and establish clear priorities, accountabilities and performance expectations.
Maintain and track contract documentation, Medicaid contract amendments, and various regulatory measures.
Work with Operational Departments to ensure that policies, procedures, and processes are developed and modified to comply with state regulatory standards.
Provide guidance to various departments with respect to regulatory and contract language.
Develop strategic relationships with agencies within the New Jersey Department of Human Services and other state regulatory policymakers with oversight responsibility for Managed Care organizations, Medicare and Medicaid initiatives.
Identify, evaluate and analyze the impact of state regulatory changes and advise management concerning impact.
Represent senior management at various state committees, meetings, and industry forums and other engagements relevant to compliance and regulatory strategy.
Maintain deep knowledge of New Jersey Medicaid and applicable state regulatory requirements.
Complies with all policies and standards.