Manager, Third Party Risk Management (Clinical_RN))

Centene Corporation • Remote-FL, MO

3d • $87,700 - $157,800 • Hybrid

About The Position

Provides clinical oversight of the organization's third-party risk management program. Manages and oversees activities to independently and objectively assess third party/subcontractor compliance with company standards, Federal and State requirements, and where applicable, additional program standards such as National Committee for Quality Assurance (NCQA) Accreditation. Drives risk mitigation strategies, coordinates cross-functional efforts, and provides strategic insights to leadership. Develops, implements, and maintains a third-party risk management framework, policies, and procedures for third parties supporting care management, population health, utilization management, and other clinical operations. Evaluates third-party compliance and performance by conducting pre-service, annual, and risk-based audits, and monitoring activities to measure performance against expectations, policies, procedures, and requirements. Manages issue resolution by identifying issues, recommending action plans, monitoring remediation activities, and reporting on corrective action plan progress. Coordinates with cross-functional teams (such as Operations, IT Security, Procurement, Compliance, etc.) to identify, evaluate, and manage third-party risks. Prepares and presents reports and dashboards for senior leadership and the board of directors. Supports internal and external audits related to third-party compliance oversight by maintaining appropriate documentation, coordinating with third parties, performing quality review of submissions, and preparing presentations to stakeholders. Monitors timely receipt of accurate and complete reporting for all regulatory and contractual-required reports for the third party. Serves as a key point of contact for third parties, providing guidance on contractual and regulatory obligations, and ensuring timely communication of new or updated requirements. Manages and mentors a team of individual contributors that support third-party risk management processes, fostering a culture of accountability and continuous improvement. Allocates resources effectively to support third-party risk management program activities. Performs other duties as assigned. Complies with all policies and standards.

Requirements

• Bachelor's Degree Business Management, Health Administration, or related equivalent work experience required.
• 5+ years Audit, Compliance, third party oversight and/or related experience required.
• Active, unrestricted Registered Nurse (RN) Upon Hire required.

Nice To Haves

• Knowledge of Medicare, Medicaid, Marketplace and health plan administration preferred.
• Project management experience in planning, coordinating and executing projects preferred.

Responsibilities

• Provides clinical oversight of the organization's third-party risk management program.
• Manages and oversees activities to independently and objectively assess third party/subcontractor compliance with company standards, Federal and State requirements and, where applicable, additional program standards such as National Committee for Quality Assurance (NCQA) Accreditation.
• Drives risk mitigation strategies, coordinate cross-functional efforts, and provides strategic insights to leadership.
• Develops, implements, and maintains third party risk management framework, policies, and procedures for third parties supporting care management, population health, utilization management and other clinical operations.
• Evaluates third party compliance and performance by conducting pre-service, annual, and risk-based audits, and monitoring activities to measure performance against expectations, policies, procedures and requirements.
• Manages issue resolution by identifying issues, recommending action plans, monitoring remediation activities and reporting on corrective action plan progress.
• Coordinates with cross-functional teams (such as Operations, IT Security, Procurement, Compliance, etc.) to identify, evaluate and manage third party risks.
• Prepares and presents reports and dashboards for senior leadership and board of directors.
• Supports internal and external audits related to third party compliance oversight by maintaining appropriate documentation, coordinating with third parties, performing quality review of submissions, and preparing presentations to stakeholders.
• Monitors timely receipt of accurate and complete reporting for all regulatory and contractual-required reports required for the third party.
• Serves as a key point of contact for third parties, providing guidance on contractual and regulatory obligations, and ensuring timely communication of new or updated requirements.
• Manages and mentors a team of individual contributors that support third party risk management processes, fostering a culture of accountability and continuous improvement.
• Allocates resources effectively to support third party risk management program activities.
• Performs other duties as assigned.
• Complies with all policies and standards.

Benefits

• competitive pay
• health insurance
• 401K and 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: Manager