Director, Regulatory Operations
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Job Description
Director overseeing Centene’s Ambetter regulatory compliance operations. Ensuring Marketplace healthcare products meet CMS, state, and federal requirements.
Responsibilities:
- Direct and oversee regulatory compliance operations for assigned products/services
- Oversee, administer, and implement the Ambetter Regulatory Operations program
- Manage regulatory complaints, complaint escalations, and grievance support
- Create processes and strategies supporting corporate compliance
- Coordinate and document Centene responses to CMS/regulator requests for information or response
- Provide guidance to departments on compliance and regulatory issues
- Ensure implementation of new compliance requirements related to regulatory and contract language
- Identify, evaluate, and analyze the impact of CMS and Marketplace regulatory issues
- Advise management on regulatory impacts
- Partner with departments to communicate and meet state and federal regulatory requirements
- Maintain and track laws, regulations, contract documentation, amendments, and compliance measures
- Ensure Marketplace products and services are tested for regulatory compliance
- Develop and update policies, procedures, and processes according to CMS and contract requirements
Requirements:
- Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future
- Bachelor's degree in Business Administration, Health Care Administration, related field or equivalent experience
- 7+ years of regulatory, compliance, operations, or related experience
- Experience preferably in a health care environment
- Advanced degree preferred
- Ability to research and apply CMS, DOI, OIG, and HIPPA regulations
- Knowledge of federal program regulations and applicable state regulations
- Knowledge of regulatory and contract language
- Ability to develop compliant policies, procedures, and processes
Benefits:
- Competitive pay
- Health insurance
- 401K
- 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
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