Manager, Ethics & Compliance

Position Purpose: Manage and implement strategies to ensure successful maintenance and implementation of compliance programs that meet regulatory requirements for assigned products across the entire company

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

• Ensure all Medicare and Medicaid product and services are being tested for compliance with program regulations, insurance regulations, and regulatory requirements for business entities.

• Maintain and track laws and regulations, contract documentations, amendments, and various compliance measures.

• Develop policies, procedures, and process to comply with federal program regulations, and any applicable state regulations.

• Provide guidance to various departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contract language.

• Conduct compliance audits, develop and implement corrective action plans.

• Perform plan risk assessments and report emerging trends, deficiencies and variances; report findings to other departments and teams as appropriate.

• Provide required Ethics, Compliance, Risk Management, FWA, privacy, and security training for existing and new employees and as required non-employees.

• Commercial Insurance (additional responsibilities):

• Monitor Commercial product risks in accordance with the risk reporting policies.

• Manage Benefit Filings and entity licensures for all products to ensure compliance with state and federal regulatory requirements.

• Work in collaboration with Marketing teams to monitor Sales & Marketing representatives and materials used in advertisements.

• Medicare (additional responsibilities):

• Monitor the FDR oversight program to ensure all Medicare and MMP plans are conducting the appropriate oversight in a timely manner.

• Report all Medicare and Medicaid product risks in accordance with the risk reporting policies.

• Partner with various departments as the local executive responsible for ensuring that state and/or federal regulatory requirements relating to business continuity and disaster recovery are communicated and met.
• Performs other duties as assigned.

• Complies with all policies and standards.

Education/Experience:

• Bachelor's Degree Business Administration, Healthcare Administration, Compliance, Law or related field; or equivalent experience required
• Master's Degree preferred
• Juris Doctor (JD) preferred
• 4+ years Compliance experience, preferably in a healthcare environment; or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position required
• 2+ years Medicaid, Medicare or Commercial Managed Care experience required
• Previous experience demonstrating effective interaction with federal and state regulatory agencies in a managed care or insurance environment 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