Full Job Description
Position Purpose:
Serves as an individual contributor and subject matter expert responsible for supporting the day-to-day execution of the Medicare Compliance Advisory program in alignment with CMS requirements and applicable federal and state regulations. Provides trusted advisory support to business and compliance leadership by providing regulatory guidance, conducting research and analysis, tracking issues, contributing to audit readiness and supporting compliance workplan activities. This role 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.
3131Execute the Medicare Compliance Program in alignment with CMS and applicable federal and state regulations, ensuring prevention, detection, and correction of noncompliance and FWA.3131Execute assignments, ensuring timely, accurate, and well-documented completion of deliverables.3131Serve as a compliance advisor and subject matter resource for Medicare programs by interpreting CMS regulations and guidance and translating requirements into clear, actionable business input; as well as advising leadership on compliance impact and implementation needs.3131Conduct regulatory research and analysis to support business inquiries, compliance advisory opinions, and implementation activities.3131Support intake, tracking, and resolution of compliance issues, including documenting findings, assessing risk, and recommending corrective actions.3131Contribute to monitoring and oversight activities by identifying regulatory risks and trends and supporting resolution of identified issues.3131Prepare draft responses and supporting materials for regulatory inquiries, audits, data requests, and internal compliance reviews.3131Maintain accurate and complete documentation of compliance activities, including issue logs, regulatory references, self-disclosures and supporting evidence. 3131Collaborate with cross-functional business partners to clarify regulatory requirements and support the implementation of compliant processes.3131Escalate compliance risks, gaps, or delays in a timely manner to support effective risk management and decision-making.3131Contribute to audit readiness by supporting documentation, process validation, and issue resolution activities.3131Identify process improvement opportunities and support initiatives to enhance compliance controls, standardization, and operational efficiency.3131Support compliance training and education initiatives, ensuring awareness of Medicare regulatory program requirements, standards of conduct, and reporting obligations.3131Performs other duties as assigned.3131Comply with all policies and standards.
Education/Experience:
31Bachelor's degree in a related field (e.g., healthcare administration, public health, policy) or equivalent experience required. Master's Degree or Juris Doctor preferred.
315+ years Compliance, regulatory, operations, or risk management within a regulated industry (e.g., healthcare, managed care, insurance, or public sector).
31Demonstrated experience interpreting and applying complex regulatory frameworks and compliance program requirements within a regulated environment into clear, actionable guidance for business stakeholders required.
31Experience leading cross-functional initiatives or large-scale compliance efforts, required.
31Experience conducting risk assessments, analyzing data, and applying structured problem-solving approaches to identify compliance risks and recommend mitigation strategies required.
31Experience effectively communicating with and managing relationships across stakeholders, including presenting complex compliance concepts to diverse audiences required.
31Demonstrated experience influencing cross-functional partners and driving outcomes in a matrixed environment without direct authority required.
31Experience supporting managed care, Medicare Advantage/Part D, or Dual Eligible (DSNP) programs.
31Foundational knowledge of Medicare regulations, including CMS guidance and compliance expectations (e.g., Parts C & D).
31Certified in Healthcare Compliance (CHC) preferred.
31Familiarity with CMS audit protocols, program audits, or monitoring activities preferred.
31Experience working in a matrixed or cross-functional environment preferred.
Licenses/Certifications:
31Certified in Healthcare Compliance (CHC) preferred.
31RN, LPN, Pharmacist, CPhT, Case Management preferred.
Pay Range: $87,700.00 - $157,800.00 per year
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.
