Offer summary

Qualifications:

Bachelor’s degree in Nursing or related field required., 5+ years of related experience required., RN or LPN license is required; certifications in HealthCare Compliance, Compliance & Ethics, Internal Auditing, or Fraud Examination are preferred., Experience in case management, utilization management, or conducting audits/reviews is highly desirable..

Key responsabilities:

Participate in auditing, monitoring, and oversight of compliance programs for Centene and its third parties.

Prepare written reports on audit findings and collaborate on compliance issues for resolution.

Support management in developing tools for evaluating compliance with healthcare program requirements.

Educate and assist internal and external stakeholders in maintaining compliance with government-sponsored healthcare programs.

Job description

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.

Position Purpose: Participate in the auditing, monitoring, and oversight of Centene's, its subsidiaries, and/or its third parties /subcontractors’ corporate ethics and compliance program, and ongoing oversight and analysis of regulatory compliance issues. Conducts audit, oversight, and monitoring activities to assess compliance with aspects of Centene’s contractual and regulatory requirements. Responsible for collaborating with business owners 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.

Prepare written reports on audit, oversight and monitoring activity findings and recommendations.
Collaborate to direct compliance issues to appropriate channels for research and resolution. Review and evaluate the status and effectiveness of corrective action plans and provide comprehensive follow up.
Support management in the development and maintenance of monitoring and auditing tools designed to evaluate internal and third party/subcontractor compliance with clinical aspects of government-sponsored health care program requirements, State Medicaid program annual work plans, and OIG and CMS work plans including but not limited to, care management utilization management, quality improvement plan management and oversight, and appeals.
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 of care management, utilization management, quality improvement plan management and oversight activities, and appeals.

This is a remote position.

The ideal candidate is a licensed RN, based in the Eastern or Central Time zone. We are particularly interested in individuals with experience in case management, utilization management, or conducting audits/reviews.

Education/Experience: Bachelor’s degree in Nursing or related field required. 5+ years of related experience required.

License/Certification: RN or LPN required. Certified in HealthCare Compliance (CHC), Certified Compliance & Ethics Professional (CCEP); Certified Internal Auditor (CIA); or Certified Fraud Examiner (CFE) preferred.

Pay Range: $68,700.00 - $123,700.00 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. Total compensation may also include additional forms of incentives.

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

Required profile