Compliance Oversight Specialist (Non Clinical)

Centene Corporation•Remote-MO, MO

4d•$56,200 - $101,000•Remote

About The Position

Centene is transforming the health of its communities, one person at a time. This role 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 audits, oversight, and monitoring of activities to assess compliance with WellCare's contractual and regulatory requirements. The specialist will collaborate with business owners and/or delegated vendors to drive remediation and assist WellCare and delegated subcontractors in maintaining integrity through oversight and monitoring and in meeting Government-sponsored healthcare program requirements. Applicants have the flexibility to work remote from home anywhere in the Continental United States.

Requirements

A Bachelor's Degree in Related field, or Associates with 4 years of applicable experience, or HSD/GED with 5 years of applicable experience in lieu of Bachelor’s degree required
Required 3+ years of experience in Managed Care/Health Insurance

Nice To Haves

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
Certified in HealthCare Compliance (CHC) preferred

Responsibilities

Conducts focused reviews and audits, 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.
Assists WellCare and delegated subcontractors to maintain integrity through oversight and monitoring and in meeting Government-sponsored health care program requirements.
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.
Complies with all policies and standards.