Director, Regulatory Operations

This is a fully remote position, open to applicants in Florida, +9 more states.

📋 Description

• Direct and manage regulatory compliance operations for designated products/services.

• Oversee, implement, and administer the Ambetter Regulatory Operations program.

• Handle regulatory complaints, escalations, and provide grievance support.

• Develop processes and strategies that enhance corporate compliance.

• Coordinate and document Centene's responses to requests for information from CMS or regulators.

• Offer guidance to departments regarding compliance and regulatory matters.

• Ensure the implementation of new compliance requirements related to regulatory and contractual language.

• Identify, assess, and analyze the effects of CMS and Marketplace regulatory issues.

• Advise management on the implications of regulatory changes.

• Collaborate with departments to communicate and fulfill state and federal regulatory obligations.

• Maintain and track laws, regulations, contract documentation, amendments, and compliance metrics.

• Ensure that Marketplace products and services undergo testing for regulatory compliance.

• Develop and revise policies, procedures, and processes in alignment with CMS and contract requirements.

⛳️ Requirements

• Must possess authorization to work in the U.S. without the necessity for employment-based visa sponsorship, both now and in the future.

• Bachelor's degree in Business Administration, Health Care Administration, a related field, or equivalent experience.

• A minimum of 7 years of experience in regulatory, compliance, operations, or a related field.

• Experience is preferred in a healthcare setting.

• An advanced degree is preferred.

• Ability to research and apply regulations from CMS, DOI, OIG, and HIPAA.

• Familiarity with federal program regulations and relevant state regulations.

• Understanding of regulatory and contractual language.

• Capability to develop compliant policies, procedures, and processes.

🏝️ Benefits

• Competitive pay.

• Health insurance.

• 401K.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off, in addition to holidays.

• Flexible work arrangements, including remote, hybrid, field, or office schedules.

• Additional forms of incentives may be included in the total compensation package.