Centene is transforming the health of our communities one person at a time. As an Executive on our team, you could be the one who changes everything for our 28 million members.
**Position Purpose:** Lead Centene's compliance strategy, ensuring regulatory compliance with all state and federal governmental agencies. Cultivate and maintain strong relationships with key organizational and strategic partners.
+ Lead compliance team to ensure current knowledge of laws, regulations, contracts, amendments, or other legal requirements are aggressively monitored for strict compliance.
+ Lead a strategically focused team to support growth, efficiency, and profitability of Centenes business.
+ Develop strategic external relationships with regulators, governmental agencies, or other organizations.
+ Provide expert counsel to internal markets, departments, or executives following analysis and impact of any changes to regulatory issues.
+ Monitor compliance, utilizing constructive data to provide actionable insight for continued growth and profitability of the product.
+ Drive efficiency within the department, with a focus on process, risk, and control.
+ Utilize data driven insight to change and/or influence technology decisions.
**Education/Experience:**
+ Bachelor's Degree in Business Administration, Healthcare Administration or related field.
+ 10+ years of experience implementing business initiatives in process, risk, and control measures required.
+ 5+ years of compliance focused solutions (HIPAA, NAIC, CMS, SOX, etc.); healthcare industry experience preferred
+ For Illinois plan only: Must reside in Illinois.
+ Shall develop and implement policies, procedures, and practices designed to ensure compliance with state and federal requirements.
+ Will oversee Program Integrity Program, the Complaint, Grievance, Special Investigations Unit, and the fair hearing process, and ensure that Fraud, Waste and Abuse is reported in accordance with state and federal guidelines.
+ Will report directly to the Plan CEO and Board of Directors.
+ Will serve as an account manager to the Department of Healthcare and Family services to facilitate communications HFS and plan leadership and staff.
+ Implement all action plans, strategies, and timelines.
+ Oversee all activities by the Plan and its First Tier, Downstream and Related Entities, including but not limited to coordinating with the Plan's quality management director, medical director, and behavioral health clinician.
+ Ensure that Enrollees receive written notice of any significant change in the manner in which Covered Services are rendered to Enrollees at least thirty (30) days before the intended effective date of the change;.
+ Receive and respond to all inquiries and requests made by CMS and HFS in time frames and formats reasonably acceptable.
+ Meet with representatives of CMS or HFS, or both, on a periodic or as-needed basis and resolve issues that arise; Ensure the availability to CMS and HFS upon eithers request, of those members of the Plan's staff who have appropriate expertise in administration, operations, finance, management information systems, claims processing and payment, clinical service provision, quality management, Enrollee services, Utilization Management, Provider Network management, and Benefit Coordination; Coordinate requests and activities among the Plan , all First Tier, Downstream, and Related Entities, CMS, and HFS.
+ Make best efforts to promptly resolve any issues related to the Contract identified by the Contractor, CMS, or HFS.
+ Meet with CMS and HFS if it is determined that the Plan is not in compliance with state and federal requirements.
+ CPA, CISA, JD, MHA, MBA, MIS, or similar preferred.
Pay Range: $223,200.00 - $422,900.00 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
**Position Purpose:** Lead Centene's compliance strategy, ensuring regulatory compliance with all state and federal governmental agencies. Cultivate and maintain strong relationships with key organizational and strategic partners.
+ Lead compliance team to ensure current knowledge of laws, regulations, contracts, amendments, or other legal requirements are aggressively monitored for strict compliance.
+ Lead a strategically focused team to support growth, efficiency, and profitability of Centenes business.
+ Develop strategic external relationships with regulators, governmental agencies, or other organizations.
+ Provide expert counsel to internal markets, departments, or executives following analysis and impact of any changes to regulatory issues.
+ Monitor compliance, utilizing constructive data to provide actionable insight for continued growth and profitability of the product.
+ Drive efficiency within the department, with a focus on process, risk, and control.
+ Utilize data driven insight to change and/or influence technology decisions.
**Education/Experience:**
+ Bachelor's Degree in Business Administration, Healthcare Administration or related field.
+ 10+ years of experience implementing business initiatives in process, risk, and control measures required.
+ 5+ years of compliance focused solutions (HIPAA, NAIC, CMS, SOX, etc.); healthcare industry experience preferred
+ For Illinois plan only: Must reside in Illinois.
+ Shall develop and implement policies, procedures, and practices designed to ensure compliance with state and federal requirements.
+ Will oversee Program Integrity Program, the Complaint, Grievance, Special Investigations Unit, and the fair hearing process, and ensure that Fraud, Waste and Abuse is reported in accordance with state and federal guidelines.
+ Will report directly to the Plan CEO and Board of Directors.
+ Will serve as an account manager to the Department of Healthcare and Family services to facilitate communications HFS and plan leadership and staff.
+ Implement all action plans, strategies, and timelines.
+ Oversee all activities by the Plan and its First Tier, Downstream and Related Entities, including but not limited to coordinating with the Plan's quality management director, medical director, and behavioral health clinician.
+ Ensure that Enrollees receive written notice of any significant change in the manner in which Covered Services are rendered to Enrollees at least thirty (30) days before the intended effective date of the change;.
+ Receive and respond to all inquiries and requests made by CMS and HFS in time frames and formats reasonably acceptable.
+ Meet with representatives of CMS or HFS, or both, on a periodic or as-needed basis and resolve issues that arise; Ensure the availability to CMS and HFS upon eithers request, of those members of the Plan's staff who have appropriate expertise in administration, operations, finance, management information systems, claims processing and payment, clinical service provision, quality management, Enrollee services, Utilization Management, Provider Network management, and Benefit Coordination; Coordinate requests and activities among the Plan , all First Tier, Downstream, and Related Entities, CMS, and HFS.
+ Make best efforts to promptly resolve any issues related to the Contract identified by the Contractor, CMS, or HFS.
+ Meet with CMS and HFS if it is determined that the Plan is not in compliance with state and federal requirements.
+ CPA, CISA, JD, MHA, MBA, MIS, or similar preferred.
Pay Range: $223,200.00 - $422,900.00 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
Job ID: 487906155
Originally Posted on: 8/3/2025
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