Manager, Ethics & Compliance

Centene   •  

Clayton, MO

Industry: Healthcare IT


5 - 7 years

Posted 396 days ago


 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

  • 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 contractlanguage
  • Conduct compliance audits, develop and implement corrective action plans
  • Perform planrisk 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 riskreporting 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 riskreporting 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



Education/Experience: Bachelors’ degree in related field or equivalent experience. Master's or Juris Doctorate degree preferred. 4+ years of compliance experience, preferably in a healthcare environment with at least 2+ years of Medicaid, Medicare or Commercial Managed Care experience. Previous experience demonstrating effective interaction with federal and state regulatory agencies in a managed care or insurance environment preferred.

Preferred:Experience in compliance privacy.  Experience with HIPAA, PCI, TCPA, EU.