Director, Duals-Compliance

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.
 

**Fully Remote Opportunity**

The ideal candidate will have:

• Expertise in Dual Eligible Special Needs Plans (D-SNPs)  (compliance, product, and operations).
• Experience in Medicare Managed Care and D-SNP compliance programs (audits, risk, regulations).
• Background in procurement and implementation
• Strong analytical, problem-solving, and critical-thinking skills.
• Solid audit experience
• Hands-on experience with CMS Program Audits (including SNP) and training development.
• Ability to work with regulators and present to agencies.
• Excellent organizational and communication skills.
• Proven leadership experience.

Position Purpose:
Oversees and supports the Dual Eligible Special Needs Plans (D-SNP) compliance functions. Ensures adherence to federal, state, and local regulatory requirements and contractual obligations. Responsible for leading the review and interpretation of regulatory guidance and D-SNP contract requirements, ensuring they are accurately understood and applied. It also involves managing internal monitoring and auditing activities to ensure alignment with the organization's compliance program, policies, and procedures.

Leads internal investigations related to D-SNP compliance issues, developing and implementing corrective action plans, and contributing to the development and execution of compliance strategies and communications. Serves as key point of contract during external audits and regulatory reviews involving D-SNP contracts, ensuring timely and accurate responses and follow-up.

• Manages approval and submission of timely and accurate D-SNP State Medicaid Agency (“SMAC”) contract and regulatory required report deliverables not limited to MMCM, CFR and state regulations.
• A strategic partner and trusted advisor for Company employees and leaders on D-SNP audit and monitoring issues, serving as a model in promoting a culture of integrity, accountability, and compliance.
• Conducts periodic assessments to ensure compliance against SMAC and regulatory requirements. Leads the development, review, revision, and presentation of regulatory and compliance policies, including the D-SNP training.
• Leverages investigative finding and emerging trends to generate actionable insights and communicate insights to business and compliance stakeholders. Drives the development of scalable, sustainable risk mitigation strategies that align with organizational goals and regulatory expectations.
• Proactively identifies and initiates compliance investigations by leveraging risk assessments, data analysis, and emerging industry trends to uncover and address potential areas of compliance risk.
• Conducts regulatory and compliance investigations, prepares high-quality written reports, and presents findings as appropriate to business and cross-functional stakeholders.
• Actively represents the organization in regulatory and industry forums, including state-led meetings specific to D-SNPs, as well as integrated Medicaid and D-SNP sessions. Partner with Health Plan leadership to coordinate participation and ensure consistent Duals Compliance representation and alignment across all relevant engagements.
• Supports responses to Request for Proposals (RFPs) and new business implementations by completing assigned compliance deliverables accurately and within established timelines. Partners with Health Plan teams to ensure responses appropriately reflect Medicaid-specific requirements for Duals plans and align with applicable federal and state D-SNP regulations. Ensures all contributions support the organization’s broader Duals strategy and compliance objectives.
• Participates in new Duals business implementations not limited to RFP that include D-SNP program, including the identification and tracking of required Dual deliverables such as state reporting, validation of D-SNP operational requirements based on D-SNP model and requirements beyond D-SNP regulations or state specific program requirements applicable to the D-SNP.
• Designs, implements and improves processes to prevent, detect and respond to compliance issues and concerns related to all federal and state regulatory requirements and SMAC requirements.
• Creates and deliver Duals compliance training for all employees on an annual basis and as needed basis, such as in response to a compliance issue or concern.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience:

• Bachelor's Degree Healthcare Administration, Compliance, or related field, or equivalent experience required
• 5+ years experience in Medicare and/or D-SNP audit and compliance, including conducting risk assessments aligned with SMAC contract and regulatory requirements, interpreting MMCM guidance, and developing and executing auditing, monitoring, and reporting processes required
• 2+ years Overseeing implementation of contract requirements required
• Proven ability to manage corrective action plans, implement compliance policies and procedures, and design and deliver effective training and education program required
• Medicare manage health experience required
• D-SNP SMAC, regulatory requirements or operations experience required
   

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