[Remote] Director, Regulatory Operations

Note: The job is a remote job and is open to candidates in USA. Centene Management Company LLC is hiring a Director, Regulatory Operations to oversee regulatory compliance operations for assigned products and services. The role manages the Ambetter Regulatory Operations program, supports regulatory responses and guidance, and ensures Marketplace products, services, policies, and processes meet applicable requirements.

Responsibilities

• Oversee, administer, and implement various aspects of the Ambetter Regulatory Operations program, including regulatory complaints, complaint escalations and grievance support
• Ability to research and apply CMS, DOI, OIG, and HIPPA regulations to create processes and strategies while ensuring corporate compliance
• Coordinate and document Centene responses to CMS/Regulator Request for Information/Response
• Provide guidance to various departments regarding compliance/regulatory issues and ensure implementation of new compliance requirements with respect to regulatory and contract language
• Identify, evaluate and analyze the impact of CMS and Marketplace regulatory issues and advise management concerning impact
• Partner with various departments to ensure that state and/or federal regulatory requirements are communicated and met
• Maintain and track laws and regulations, contract documentations, amendments, and various compliance measures
• Ensure all Marketplace products and services are being tested for compliance with program regulations, insurance regulations, and regulatory requirements for business entities
• Develop policies, procedures, and process to comply with federal program regulations, and any applicable state regulations; ensure policies and procedures are updated according to CMS/contract requirements

Skills

• 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, preferably in a health care environment
• Advanced degree preferred

Benefits

• Health insurance (subject to program eligibility).
• 401K and stock purchase plans (subject to program eligibility).
• Tuition reimbursement (subject to program eligibility).
• Paid time off plus holidays (subject to program eligibility).
• A flexible approach to work with remote, hybrid, field or office work schedules (subject to program eligibility).

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