Director, Regulatory Operations
Required skills
- regulatory compliance
- regulatory operations
- CMS
- DOI
- OIG
- HIPAA
- Ambetter
- regulatory complaints
- complaint escalations
- grievance support
Nice to have
- health care environment
Role summary
Centene is seeking a Director, Regulatory Operations to lead and manage regulatory compliance for assigned products and services. This fully remote role involves overseeing the Ambetter Regulatory Operations program, including complaints and escalations, and ensuring adherence to CMS, DOI, OIG, and HIPAA regulations. The Director will research and apply regulations, develop processes and strategies, coordinate responses to regulators, provide compliance guidance, analyze regulatory impacts, and ensure products meet all compliance requirements. The position requires a Bachelor's degree or equivalent experience and 7+ years of regulatory, compliance, or operations experience, preferably in healthcare.
Position Purpose: Direct and oversee regulatory compliance operations to ensure fully compliance with all applicable laws and regulations for assigned products/services.
Key Details: The role is fully remote. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.
- 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.
At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
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.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
Originally posted on Himalayas
Similar roles
- HEDIS Quality and Audit AnalystCentene Corporation · Remote · Remote
- Care Coordinator II, STAR KidsCentene Corporation · Remote Tx, TX · Hybrid
- Sr Manager/Assoc Director, Regulatory OperationsErasca · Remote · Remote
- Associate Director, Regulatory OperationsAcadia Pharmaceuticals Inc. · Princeton, NJ · Hybrid
Regulatory Operations SpecialistAdelphi Group · New York · Hybrid- Senior Business Operations Manager, Integrity, Risk, and Regulatory OperationsEtsy · Brooklyn, NY · Hybrid
