Director, Regulatory Operations
Centene Corporation
full-time
Posted on:
Location Type: Hybrid
Location: Detroit • Missouri • 🇺🇸 United States
Visit company websiteSalary
💰 $110,900 - $205,000 per year
Job Level
Lead
About the role
- 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
- 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
Requirements
- 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
- Ability to research and apply CMS, DOI, OIG, and HIPPA regulations
- Experience coordinating/documenting responses to CMS Request for Information/Response
- Experience developing policies, procedures, and processes to comply with federal program regulations
- Ability to partner with various departments and provide guidance regarding compliance issues
- Must reside in Michigan and report into the office weekly (hybrid)
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
- Total compensation may also include additional forms of incentives
- Benefits may be subject to program eligibility
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
regulatory complianceMedicare Compliance programCMS regulationsDOI regulationsOIG regulationsHIPAA regulationspolicy developmentprocedure developmentprocess implementationcontract compliance
Soft skills
guidancecommunicationcollaborationanalytical skillsproblem-solvingorganizational skillsleadershipresearch skillsadaptabilityattention to detail
Certifications
Bachelor's degreeAdvanced degree (preferred)Compliance certification (e.g., CHC, CCEP)