Position Purpose:
Participate in the auditing, monitoring, and oversight of Centene's, its broker and distribution partners, subsidiaries, and/or its third parties /subcontractors' corporate ethics and compliance program, and ongoing oversight and analysis of regulatory compliance issues. Conduct audit, oversight, and monitoring activities to assess compliance with aspects of Centene's contractual and regulatory requirements. Responsible for collaborating with business owners, broker and distribution partners, and/or third parties/subcontractors to drive remediation and assist Centene and third parties/subcontractors to maintain integrity through audit, oversight and monitoring and in meeting government-sponsored health care program requirements. Educate brokers on audit findings, program requirements and policies and procedures. Create and deliver corrective action plans, monitor probationary periods and disciplinary actions.

Key Details:  Applicants for this job have the flexibility to work remote from home anywhere in the Continental United States.

• Prepare formal written reports on audit, oversight and monitoring activity findings and recommendations.
• Collaborate to direct compliance issues to appropriate channels for research and resolution.
• Serve as a key contributor to Issue Management by Rreviewing and evaluatinge the status and effectiveness of corrective action plans, tracking identified issues through remediation and closure, and providinge comprehensive follow up.
• Communicate the importance of compliance and the Compliance Program, including promoting increased awareness of the Enterprise Ethics and Compliance Program; understanding of new and existing compliance issues and related policies and procedures; and importance of implementing and maintaining effective oversight and monitoring activities.
• Support management in the development and maintenance of monitoring and auditing tools designed to evaluate internal, brokers and distribution partners and/or third party/subcontractor compliance with aspects of government-sponsored health care program requirements. May also include state Medicaid annual work plans, OIG/CMS initiatives across claims, credentialing, network management and customer service functions.
• Educate, encourage, and assist those within the company and with the company’s third parties/subcontractors to maintain integrity through oversight and monitoring and in meeting the requirements of Government-sponsored health care programs.
• Assist in the assessment of new and amended government-sponsored health care program contracts and requirements.
• Assist Health Plans, Subsidiaries, Shared Services, and Third Parties/Subcontractors in the identification and assessment of compliance risks.
• Serve as a compliance advisor to business units and third parties with specialized focus, including but not limited to, claims / payments, credentialing, network management, financial solvency.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience:

• Bachelor's Degree in Healthcare, Audit, Business, or related field or equivalent experience required; or High School/GED and 5+ years of related experience required

Licenses/Certifications:

• CHC - Certified Healthcare Compliance preferred
• Certified Internal Auditor (CIA) preferred
  

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
 

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