Senior Compliance Oversight Specialist, RN

This is a fully remote position, open to applicants in Florida, +1 more state.

📋 Description

• Engage in the auditing, monitoring, and oversight of Centene, along with its subsidiaries and third parties/subcontractors, regarding corporate ethics and compliance programs.

• Execute audit, oversight, and monitoring activities to evaluate adherence to contractual and regulatory obligations.

• Collaborate with business owners and third parties/subcontractors to facilitate remediation efforts.

• Draft written reports detailing audit, oversight, and monitoring results along with recommendations.

• Direct compliance concerns to the appropriate channels for investigation and resolution.

• Review and assess corrective action plans while providing thorough follow-up.

• Aid in the development and upkeep of monitoring and auditing tools related to the clinical aspects of government-sponsored healthcare program requirements.

• Contribute to State Medicaid annual work plans and OIG and CMS work plans, encompassing care management, utilization management, quality improvement plan oversight, and appeals.

• Educate and assist company personnel and third parties/subcontractors in fulfilling government-sponsored healthcare program requirements.

• Evaluate new and modified government-sponsored healthcare program contracts and their requirements.

• Support Health Plans, Subsidiaries, Shared Services, and Third Parties/Subcontractors in pinpointing and evaluating compliance risks.

• Act as a compliance advisor to business units and third parties, specializing in care management, utilization management, quality improvement plan oversight, and appeals.

• Perform additional duties as assigned.

⛳️ Requirements

• Bachelor’s degree in Nursing or a related field is required.

• A minimum of 5 years of relevant experience is required.

• RN or LPN certification is required.

• Certification in HealthCare Compliance (CHC), Certified Compliance & Ethics Professional (CCEP), Certified Internal Auditor (CIA), or Certified Fraud Examiner (CFE) is preferred.

• Previous experience in Care Management and/or Utilization Management is preferred.

• Audit experience is preferred.

• Must adhere to all policies and standards.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement opportunities.

• Paid time off in addition to holidays.

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

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

• Benefits may be subject to program eligibility.