Vice President, Compliance

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: Ensure regulatory compliance with state and other government agencies related to the health insurance industry, Centene Corporation, and its business subsidiaries.

• Ensure business unit and Centene Corporate are in compliance with state and federal program regulations, insurance regulations, regulatory requirements for business entities and state contract requirements.
• Maintain and track laws and regulations, contract documentations, amendments, and various compliance measures.
• Develop policies, procedures, and processes to comply with state law, federal law, contract requirements, and various standards
• Oversee, administer, and implement various compliance programs, including fraud and abuse and HIPAA
• Provide guidance to various departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contract language
• Conduct compliance audits, develop and implement corrective action plans, and report on achievement of action plans to senior management and Board of Directors
• Develop strategic relationships with state legislative policymakers and assist with the development of state legislative public policy concerning state insurance, Managed Care Organization, Medicare and Medicaid regulations and initiatives
• Identify, evaluate and analyze the impact of state legislative and regulatory issues and advise management concerning impact
• Represent senior management at various committees, meetings, and seminars
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience:

Bachelor's Degree in Public Policy, Government Affairs, Business Administration or related field required

Master's Degree or Law degree preferred

8+ years of compliance program management and contract experience required Extensive knowledge of state administrative code and regulations, state insurance laws and regulations including managed care regulations Experience with state and federal government agencies, accreditation bodies, participating provider agreements, HIPAA and Third Party Administration (TPA) laws, credentialing regulations and prompt pay laws

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

Originally posted on Himalayas