Director, Compliance & Risk Processes & Initiatives at Centene

You are a seasoned compliance professional with at least seven years of experience managing Medicaid, Medicare, or commercial programs and a bachelor’s degree.

Work type: remote

Location: Remote-MO

Type: Full-time

Summary

You are a seasoned compliance professional with at least seven years of experience managing Medicaid, Medicare, or commercial programs and a bachelor’s degree. You have a background in internal and state audits and understand how to build governance and risk frameworks within healthcare organizations. **What makes it worth a look...** Centene is offering a fully remote role based anywhere in the Continental United States. While specific salary figures are not disclosed, the position includes a comprehensive benefits package with a 401K plan, stock purchase options, and tuition reimbursement. **You might be a good fit if you...** * Have seven or more years of experience with federal and state healthcare regulatory programs. * Possess hands-on experience using GRC platforms, specifically Archer Evolv. * Can translate complex business requirements into technical documentation for IT and system teams. * Know how to design evaluation rubrics for compliance risk initiatives.

Job Description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
 

Applicants for this job have the flexibility to work remote from home anywhere in the Continental United States.Position Purpose:
Develops and implements strategies to ensure successful maintenance and implementation of compliance and risk programs that meet regulatory requirements for assigned products across the enterprise, leveraging strong collaboration, and project management skills to build and continuously improve governance, risk, and compliance (GRC) processes, controls, and tool capabilities, informed by a background in compliance and/or auditing and a person-centered approach to accomplishing goals.

• Champions cross-functional collaboration by working closely with Risk & Compliance teams, business units, legal, IT, and operational leaders to develop, refine, and implement comprehensive compliance and risk management processes and controls, and training.


• Leads the documentation of processes and controls, ensuring that methodologies, procedures, and control frameworks are clearly articulated, standardized, and accessible. Oversee the review and periodic update of compliance process documentation to reflect evolving regulatory requirements and organizational priorities.


• Coordinates with the GRC Administration team, Compliance Systems & Reporting to translate business needs into actionable technology requirements to support compliance and risk activities. Serve as the principal liaison between business/process stakeholders, GRC Administration team, and technology teams to identify, specify, and prioritize requirements for integrating processes and controls within the Governance, Risk & Compliance platform (Archer Evolv).


• Architects and implements governance structures for the GRC application, establishing roles, responsibilities, oversight mechanisms, and escalation protocols. Ensure governance frameworks align with industry best practices and regulatory expectations, promoting effective utilization and continuous improvement of the GRC tool.


• Designs and maintains robust standards and criteria for business cases submitted to the governance committee. Develop objective evaluation rubrics, ensuring proposals for compliance and risk initiatives are rigorously assessed for business value, regulatory impact, resource allocation, and strategic alignment prior to approval.


• Leads efforts to ensure the accuracy and currency of field values within the GRC application. Establish and direct regular evaluation procedures with business/process stakeholders to verify that all data fields are up to date, reliable, and aligned with current business and regulatory standards.


• Develops a framework to evaluate and interpret data outputs and reporting generated from activities recorded in the GRC tool to ensure data-driven insights can be derived to guide decision-making and support regulatory, audit, and operational requirements.


• Champions other strategic initiatives as assigned supporting Risk & Compliance Programs.


• Performs other duties as assigned.


• Complies with all policies and standards.

• Bachelor's Degree Business Administration or related field; or equivalent experience required


• 7+ years Compliance program management and contract experience with state Medicaid, Medicare or commercial programs, including internal and state audits required


• Working with healthcare regulatory agencies to develop compliance and fraud prevention programs preferred


• Overseeing the implementation of federal and state insurance or program requirement preferred


• Utilization of various Governance, Risk, and Compliance applications preferred

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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