Manager, Third Party Risk Management (Clinical_RN))

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:
Provides clinical oversight of the organization's third-party risk management program. Manage and oversee activities to independently and objectively assess third party/subcontractor compliance with company standards, Federal and State requirements and, where applicable, additional program standards such as National Committee for Quality Assurance (NCQA) Accreditation. Drives risk mitigation strategies, coordinate cross-functional efforts, and provides strategic insights to leadership.

• Develops, implements, and maintains third party risk management framework, policies, and procedures for third parties supporting care management, population health, utilization management and other clinical operations.
• Evaluates third party compliance and performance by conducting pre-service, annual, and risk-based audits, and monitoring activities to measure performance against expectations, policies, procedures and requirements.
• Manages issue resolution by identifying issues, recommending action plans, monitoring remediation activities and reporting on corrective action plan progress.
• Coordinates with cross-functional teams (such as Operations, IT Security, Procurement, Compliance, etc.) to identify, evaluate and manage third party risks.
• Prepares and presents reports and dashboards for senior leadership and board of directors.
• Supports internal and external audits related to third party compliance oversight by maintaining appropriate documentation, coordinating with third parties, performing quality review of submissions, and preparing presentations to stakeholders.
• Monitors timely receipt of accurate and complete reporting for all regulatory and contractual-required reports required for the third party.
• Serves as a key point of contact for third parties, providing guidance on contractual and regulatory obligations, and ensuring timely communication of new or updated requirements.
• Manages and mentors a team of individual contributors that support third party risk management processes, fostering a culture of accountability and continuous improvement.
• Allocates resources effectively to support third party risk management program activities.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience:

Bachelor's Degree Business Management, Health Administration, or related equivalent work experience required.

5+ years Audit, Compliance, third party oversight and/or related experience required.

Knowledge of Medicare, Medicaid, Marketplace and health plan administration preferred.

Project management experience in planning, coordinating and executing projects preferred.

Licenses/Certifications:
Active, unrestricted Registered Nurse (RN) Upon Hire 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