Director, Regulatory Operations

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

This is a hybrid positions that does require the individual to reside in Michigan and report into the office weekly.

Position Purpose: Direct and oversee regulatory compliance operations to ensure fully compliance with all applicable laws and regulations for assigned products/services.

• Oversee, administer, and implement various aspects of the Medicare Compliance program, including HPMS communication/regulation
• Ability to 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 Request for Information/Response
• Provide guidance to various departments regarding compliance issues and ensure implementation of new compliance requirements with respect to regulatory and contract language
• Identify, evaluate and analyze the impact of CMS and Medicare 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 Medicare products and services are being tested for compliance with program regulations, insurance regulations, and regulatory requirements for business entities
• Develop policies, procedures, and process to comply with federal program regulations, and any applicable state regulations; ensure policies and procedures are updated according to CMS/contract requirements

Education/Experience: 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 Advanced degree preferred.Pay Range: $110,900.00 - $205,000.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act