Director, Regulatory Operations

Centene Corporation•Remote-MO, NV

1d•$107,700 - $199,300•Remote

About The Position

Centene is seeking a Director, Regulatory Operations to direct and oversee regulatory compliance operations, ensuring full compliance with all applicable laws and regulations for assigned products/services. This role is crucial in connecting people to the care they need to live healthier lives, with work that makes a real impact every day. You will take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

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.
Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.
Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

Nice To Haves

Advanced degree preferred.

Responsibilities

Oversee, administer, and implement various aspects of the Ambetter Regulatory Operations program, including regulatory complaints, complaint escalations and grievance support.
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/Regulator Request for Information/Response.
Provide guidance to various departments regarding compliance/regulatory issues and ensure implementation of new compliance requirements with respect to regulatory and contract language.
Identify, evaluate and analyze the impact of CMS and Marketplace 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 Marketplace products and services are being tested for compliance with program regulations, insurance regulations, and regulatory requirements for business entities.
Develop policies, procedures, and processes to comply with federal program regulations, and any applicable state regulations; ensure policies and procedures are updated according to CMS/contract requirements.