Senior Compliance Oversight Specialist (RN)
About The Position
The Senior Compliance Oversight Specialist participates in auditing, monitoring, and oversight of Centene’s and its subsidiaries’ corporate ethics and compliance program, including oversight of third parties and subcontractors, and ongoing analysis of regulatory compliance issues. The role conducts audit, oversight, and monitoring activities to assess compliance with contractual and regulatory requirements. It collaborates with business owners and external partners to drive remediation and support compliance with government-sponsored health care program requirements. The position also supports compliance oversight focused on care management, utilization management, quality improvement plan management and oversight, and appeals. It helps assess compliance risks and new or amended program contracts and requirements, and advises business units and third parties on compliance matters. This is a remote position.
Requirements
- Bachelor’s degree in Nursing or a related field.
- At least 5 years of related experience.
- RN or LPN license/certification.
Nice To Haves
- Previous experience in Care Management and/or Utilization Management.
- Audit experience.
- Certification in HealthCare Compliance (CHC), Certified Compliance & Ethics Professional (CCEP), Certified Internal Auditor (CIA), or Certified Fraud Examiner (CFE).
Responsibilities
- Prepare written reports on audit, oversight, and monitoring findings and recommendations.
- Collaborate to direct compliance issues to appropriate channels for research and resolution.
- Review and evaluate the status and effectiveness of corrective action plans and provide comprehensive follow-up.
- Support management in developing and maintaining monitoring and auditing tools to evaluate internal and third-party/subcontractor compliance with clinical aspects of government-sponsored health care program requirements, State Medicaid program annual work plans, and OIG and CMS work plans.
- Educate, encourage, and assist company personnel and third parties/subcontractors in maintaining integrity through oversight and monitoring and meeting government-sponsored health care program requirements.
- Assist in assessing new and amended government-sponsored health care program contracts and requirements.
- Assist Health Plans, Subsidiaries, Shared Services, and Third Parties/Subcontractors in identifying and assessing compliance risks.
- Serve as a compliance advisor to business units and third parties, with specialized focus on care management, utilization management, quality improvement plan management and oversight, and appeals.
- Perform other duties as assigned.
- Comply with all policies and standards.
Benefits
- Competitive pay
- Health insurance
- 401(k) and stock purchase plans
- Tuition reimbursement
- Paid time off and holidays
- Flexible work approach with remote, hybrid, field, or office schedules
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Senior
