CC
Senior Compliance Administrator - Clinical, SNP Model of Care, Care Management,
Contract type
Part-time
Work mode
Remote
Experience
Senior · 5+ years
Job description
Individual contributor and subject matter expert supporting the day-to-day execution of the Medicare Compliance Advisory program in alignment with CMS requirements and applicable federal and state regulations. Provides regulatory guidance, research and analysis, issue tracking, audit readiness and compliance workplan support to business and compliance leadership.
At a glance
- Work mode
- Remote
- Pay
- USD 87,700 – 157,800 / year
What you'll do
- Execute the Medicare Compliance Program in alignment with CMS and applicable federal and state regulations, ensuring prevention, detection, and correction of noncompliance and FWA.
- Interprets and translates federal, state, and contractual requirements into clear, actionable compliance guidance for business stakeholders, ensuring consistent understanding and application across operations.
- Develops and coordinates regulatory communications, including responses to inquiries, issue summaries, and disclosures, while serving as a liaison with internal stakeholders and external regulators as appropriate.
- Supports the preparation, validation, and submission of regulatory reports, attestations, and filings, ensuring accuracy, completeness, and timeliness of all deliverables.
- Proactively identifies compliance risks and evaluates business processes to assess exposure, provide risk stratification, and recommend mitigation strategies.
- Leads or supports issue identification, root cause analysis, and development of corrective action plans to ensure effective and compliant resolution of identified gaps.
- Provides subject matter expertise to audit and monitoring activities, including supporting audit scope development, testing strategies, and ongoing compliance oversight.
- Partners with internal and external stakeholders to support audit execution, regulatory reviews, and ongoing audit readiness activities.
- Evaluates remediation plans and validates corrective actions to ensure sustainable and compliant resolution of issues, including assessment of regulatory reporting or disclosure requirements.
- Contributes to the development and delivery of compliance training, while mentoring stakeholders on regulatory requirements, policies, and best practices.
- Reviews and assesses policies, procedures, and business processes to ensure alignment with regulatory and contractual requirements and organizational standards.
- Leads or contributes to cross-functional initiatives to enhance compliance processes, drive operational efficiency, and align compliance activities with organizational objectives.
- Monitors regulatory developments and industry trends to identify emerging risks and support continuous improvement of compliance programs.
- Collaborates with compliance, legal, audit, and operational partners to ensure coordinated execution of compliance activities across business areas.
- Performs other duties as assigned.
- Complies with all policies and standards.
What we're looking for
- Bachelor's degree in a related field (e.g., healthcare administration, public health, policy) or equivalent experience required.
- 5+ years Compliance, regulatory, operations, or risk management within a regulated industry (e.g., healthcare, managed care, insurance, or public sector).
- 4+ years Compliance advisory experience to include regulatory research and drafting compliance guidance, assessing risk, issue tracking, auditing / monitoring, and overseeing the development and implementation of correction action plans required.
- 2+ years experience supporting managed care, Medicare Advantage/Part D, or Dual Eligible (DSNP) programs.
- Foundational knowledge of Medicare regulations, including CMS guidance and compliance expectations (e.g., Parts C & D).
- Strong written and verbal communication skills.
- Strong analytical, organizational and documentation skills with attention to detail.
- Ability to manage multiple assignments and meet deadlines in a fast-paced environment.
Nice to have
- Master's Degree or Juris Doctor preferred.
- Certified in Healthcare Compliance (CHC) preferred.
- Familiarity with CMS audit protocols, program audits, or monitoring activities preferred.
- Experience working in a matrixed or cross-functional environment preferred.
- Related / relevant licensure (e.g. RN, LPN, Pharmacist, CPhT, Case Management) preferred.
Your team
Medicare Compliance Advisory
Partners closely with the Sr. Manager, Medicare Compliance Advisory to ensure accurate interpretation of CMS requirements, timely completion of assignments, and consistent documentation of compliance risks, trends, and corrective actions.
Benefits
- Competitive pay
- Health insurance
- 401K and stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- Flexible approach to work with remote, hybrid, field or office work schedules
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About Centene Corporation
We connect people to the care they need to live healthier lives
Centene offers a comprehensive benefits package and a flexible approach to work with remote, hybrid, field or office work schedules.
Mission
To connect people to the care they need to live healthier lives and make healthcare more accessible and effective.