Manager, Compliance & State Reporting
Position Purpose: Design and implement programs, policies, and practices to ensure State and Federal program contract compliance, as well as compliance with federal and state legal and regulatory requirements.
Oversee the day-to-day health plan policies and procedures to ensure federal and state regulatory compliance
Validate state and federal deliverable reports for accuracy and ensure timeliness of submission
Review and analysis of health plan deliverables and data to identify trends in performance and opportunities for improvement
Ensure timely, accurate and appropriate submission of all State filings related to health plan licensure
Act as a resource to staff in all health plan departments related to contract and reporting requirements and regulatory compliance
Act as a liaison with State and/or federal agency staff in response to inquiries and requests for information
Facilitate the administrative review process with the state including the corrective action updates that result from less than full compliance on the review standards
Interact with other compliance department personnel on fraud and abuse prevention efforts
Conduct oversight audits of health plan procedures and processes to ensure compliance with contractual and regulatory requirements
Perform List of Excluded Individuals/Entities (LEIE) exclusion checks on subcontractor, vendors and staff
Manage Compliance 360 functions, enter all correspondence from our state entity and open needed actions for tracking
Conduct/manage training programs for all health plan staff as required by contract and applicable regulatory requirements
Education/Experience: Bachelor s degree in related field or equivalent experience. 4 years of compliance or regulatory experience in a health care and/or managed care setting/organization.
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.
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Website : http://www.centene.com
Founded as a single health plan in 1984, Centene Corporation (Centene) has established itself as a national leader in the healthcare services field. Today, through a comprehensive portfolio of innovative solutions, we remain deeply committed to delivering results for our stakeholders: state governments, members, providers, uninsured individuals and families, and other healthcare and commercial organizations