Compliance Oversight Specialist – Non Clinical
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Job Description
Compliance Oversight Specialist monitoring WellCare’s managed-care contracts and regulatory programs for Centene, a healthcare solutions provider. Conducting audits, risk assessments, remediation, and corrective-action follow-up across markets and delegated subcontractors.
Responsibilities:
- Participate in oversight of WellCare's and/or delegated subcontractors' corporate ethics and compliance programs
- Conduct focused reviews, audits, oversight, and monitoring activities to assess contractual and regulatory compliance
- Collaborate with business owners and delegated vendors to drive remediation
- Assist WellCare and delegated subcontractors in meeting Government-sponsored health care program requirements
- Assess new and amended Government-sponsored health care program contracts and requirements
- Assist local Markets, corporate Shared Services, and delegated subcontractors in identifying and assessing compliance risks
- Evaluate the effectiveness of compliance programs, policies, and procedures
- Prepare timely formal written reports on findings and recommendations
- Prepare workpapers in accordance with departmental standards and maintain sufficient evidentiary material
- Direct compliance issues to appropriate channels for research and resolution
- Review and evaluate corrective action plans and provide follow-up to stakeholders, senior management, oversight committees, and the Board's Audit, Finance, and Regulatory Compliance Committee
- Participate in special projects, including training
- Perform other duties as assigned
- Comply with all policies and standards
Requirements:
- Bachelor's Degree in a related field, or Associate's degree with 4 years of applicable experience, or HSD/GED with 5 years of applicable experience in lieu of Bachelor's degree required
- 3+ years of experience in Managed Care/Health Insurance required
- 1+ year of experience in a project oversight role with demonstrated ability to drive implementation and influence others preferred
- 1+ year of experience reading, analyzing, and interpreting State and Federal laws, rules, and regulations preferred
- 1+ year of experience in State Medicaid or Federal managed care compliance preferred
- Certified in HealthCare Compliance (CHC) preferred
- Compliance with all applicable policies and standards
- Qualified applicants must meet applicable legal employment requirements
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
- Additional forms of incentives may be included in total compensation
- Accommodation support for candidates
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