10 jobs found

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 role will have the flexibility to work remotely anywhere in Continental United States. Position Purpose: Provides strategic leadership and management of department overseeing compliance with regulations and laws related to Risk Adjustment across our Marketplace, Medicaid and Medicare lines of business, which includes implementation of elements of an effective compliance program. Oversee the development of risk assessments oversight and the monitoring work plans pertaining to Risk Adjustment. Partners with business areas to ensure and implement effective prevention, detection and correction of compliance issues. Establishes and maintains a process for overseeing compliance with regulations and laws related to Risk Adjustment requirements. Provides guidance to various business departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contractual language. Conducts compliance reviews and manages team that conducts compliance reviews, assisting with identification of issues and collaborating with Corrections team for remediation of issues. Performs risk assessments and report emerging trends, deficiencies and variances, report findings to other departments and teams as appropriate. Ensure sufficient monitoring activities to assist with prevention and proactive identification of compliance concerns. Develops and monitors metrics and other oversight tools that indicate business area compliance. Provides compliance guidance, direction, and compliance risk assessment to assigned business partners. Plans and collaborates with other teams and leaders on complex projects/programs necessitating the origination and application of new and unique approaches. Sets operational priorities including the development and maintenance of effective oversight activities and prioritization of work. Responsible for Board and Executive reporting related to responsibilities of the team and compliance of business operations for which you oversee. Educates, encourages, and assists those within the company to maintain integrity through correction of identified non-compliance in order to meet the requirements of Government-sponsored health care programs. Participates in mock and actual CMS and other regulatory audits and coordinates with Internal Audit, Regulatory Compliance and/or Market based Regulatory Affairs on responses to agency inquiries and oversees the internal and external processes required to ensure the Company maintains a consistent state of Audit readiness. Maintains a current working knowledge of various laws, regulations, and industry guidance that impacts the health industry generally, and government programs in the health sector specifically, including fraud and abuse and anti-kickback statutes, OIG and government health plan guidelines and state marketing compliance laws, prompt pay, provider adequacy and other laws. Performs other duties as assigned. Complies with all policies and standards. Education/Experience: Bachelor's Degree in Business Administration, Public Policy, Public Health, Health Administration, related field, or equivalent experience required. Master's Degree CPA, CISA, JD, MHA, MBA, MIS or equivalent experience preferred 10+ years Compliance experience, preferably in a healthcare environment, or equivalent experience preferred 4+ years Management experience preferred 4+ years' Experience with risk adjustment processes, procedures, and oversight of same preferred Licenses/Certifications: HCCA certification (CHC) or equivalent preferred Pay Range: $145,100.00 - $268,800.00 per year 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

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 role will have the flexibility to work remotely anywhere in Continental United States. Position Purpose: Provides strategic leadership and management of department overseeing compliance with regulations and laws related to Risk Adjustment across our Marketplace, Medicaid and Medicare lines of business, which includes implementation of elements of an effective compliance program. Oversee the development of risk assessments oversight and the monitoring work plans pertaining to Risk Adjustment. Partners with business areas to ensure and implement effective prevention, detection and correction of compliance issues. Establishes and maintains a process for overseeing compliance with regulations and laws related to Risk Adjustment requirements. Provides guidance to various business departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contractual language. Conducts compliance reviews and manages team that conducts compliance reviews, assisting with identification of issues and collaborating with Corrections team for remediation of issues. Performs risk assessments and report emerging trends, deficiencies and variances, report findings to other departments and teams as appropriate. Ensure sufficient monitoring activities to assist with prevention and proactive identification of compliance concerns. Develops and monitors metrics and other oversight tools that indicate business area compliance. Provides compliance guidance, direction, and compliance risk assessment to assigned business partners. Plans and collaborates with other teams and leaders on complex projects/programs necessitating the origination and application of new and unique approaches. Sets operational priorities including the development and maintenance of effective oversight activities and prioritization of work. Responsible for Board and Executive reporting related to responsibilities of the team and compliance of business operations for which you oversee. Educates, encourages, and assists those within the company to maintain integrity through correction of identified non-compliance in order to meet the requirements of Government-sponsored health care programs. Participates in mock and actual CMS and other regulatory audits and coordinates with Internal Audit, Regulatory Compliance and/or Market based Regulatory Affairs on responses to agency inquiries and oversees the internal and external processes required to ensure the Company maintains a consistent state of Audit readiness. Maintains a current working knowledge of various laws, regulations, and industry guidance that impacts the health industry generally, and government programs in the health sector specifically, including fraud and abuse and anti-kickback statutes, OIG and government health plan guidelines and state marketing compliance laws, prompt pay, provider adequacy and other laws. Performs other duties as assigned. Complies with all policies and standards. Education/Experience: Bachelor's Degree in Business Administration, Public Policy, Public Health, Health Administration, related field, or equivalent experience required. Master's Degree CPA, CISA, JD, MHA, MBA, MIS or equivalent experience preferred 10+ years Compliance experience, preferably in a healthcare environment, or equivalent experience preferred 4+ years Management experience preferred 4+ years' Experience with risk adjustment processes, procedures, and oversight of same preferred Licenses/Certifications: HCCA certification (CHC) or equivalent preferred Pay Range: $145,100.00 - $268,800.00 per year 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

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 role will have the flexibility to work remotely anywhere in Continental United States. Position Purpose: Provides strategic leadership and management of department overseeing compliance with regulations and laws related to Risk Adjustment across our Marketplace, Medicaid and Medicare lines of business, which includes implementation of elements of an effective compliance program. Oversee the development of risk assessments oversight and the monitoring work plans pertaining to Risk Adjustment. Partners with business areas to ensure and implement effective prevention, detection and correction of compliance issues. Establishes and maintains a process for overseeing compliance with regulations and laws related to Risk Adjustment requirements. Provides guidance to various business departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contractual language. Conducts compliance reviews and manages team that conducts compliance reviews, assisting with identification of issues and collaborating with Corrections team for remediation of issues. Performs risk assessments and report emerging trends, deficiencies and variances, report findings to other departments and teams as appropriate. Ensure sufficient monitoring activities to assist with prevention and proactive identification of compliance concerns. Develops and monitors metrics and other oversight tools that indicate business area compliance. Provides compliance guidance, direction, and compliance risk assessment to assigned business partners. Plans and collaborates with other teams and leaders on complex projects/programs necessitating the origination and application of new and unique approaches. Sets operational priorities including the development and maintenance of effective oversight activities and prioritization of work. Responsible for Board and Executive reporting related to responsibilities of the team and compliance of business operations for which you oversee. Educates, encourages, and assists those within the company to maintain integrity through correction of identified non-compliance in order to meet the requirements of Government-sponsored health care programs. Participates in mock and actual CMS and other regulatory audits and coordinates with Internal Audit, Regulatory Compliance and/or Market based Regulatory Affairs on responses to agency inquiries and oversees the internal and external processes required to ensure the Company maintains a consistent state of Audit readiness. Maintains a current working knowledge of various laws, regulations, and industry guidance that impacts the health industry generally, and government programs in the health sector specifically, including fraud and abuse and anti-kickback statutes, OIG and government health plan guidelines and state marketing compliance laws, prompt pay, provider adequacy and other laws. Performs other duties as assigned. Complies with all policies and standards. Education/Experience: Bachelor's Degree in Business Administration, Public Policy, Public Health, Health Administration, related field, or equivalent experience required. Master's Degree CPA, CISA, JD, MHA, MBA, MIS or equivalent experience preferred 10+ years Compliance experience, preferably in a healthcare environment, or equivalent experience preferred 4+ years Management experience preferred 4+ years' Experience with risk adjustment processes, procedures, and oversight of same preferred Licenses/Certifications: HCCA certification (CHC) or equivalent preferred Pay Range: $145,100.00 - $268,800.00 per year 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

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 role will have the flexibility to work remotely anywhere in Continental United States. Position Purpose: Provides strategic leadership and management of department overseeing compliance with regulations and laws related to Risk Adjustment across our Marketplace, Medicaid and Medicare lines of business, which includes implementation of elements of an effective compliance program. Oversee the development of risk assessments oversight and the monitoring work plans pertaining to Risk Adjustment. Partners with business areas to ensure and implement effective prevention, detection and correction of compliance issues. Establishes and maintains a process for overseeing compliance with regulations and laws related to Risk Adjustment requirements. Provides guidance to various business departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contractual language. Conducts compliance reviews and manages team that conducts compliance reviews, assisting with identification of issues and collaborating with Corrections team for remediation of issues. Performs risk assessments and report emerging trends, deficiencies and variances, report findings to other departments and teams as appropriate. Ensure sufficient monitoring activities to assist with prevention and proactive identification of compliance concerns. Develops and monitors metrics and other oversight tools that indicate business area compliance. Provides compliance guidance, direction, and compliance risk assessment to assigned business partners. Plans and collaborates with other teams and leaders on complex projects/programs necessitating the origination and application of new and unique approaches. Sets operational priorities including the development and maintenance of effective oversight activities and prioritization of work. Responsible for Board and Executive reporting related to responsibilities of the team and compliance of business operations for which you oversee. Educates, encourages, and assists those within the company to maintain integrity through correction of identified non-compliance in order to meet the requirements of Government-sponsored health care programs. Participates in mock and actual CMS and other regulatory audits and coordinates with Internal Audit, Regulatory Compliance and/or Market based Regulatory Affairs on responses to agency inquiries and oversees the internal and external processes required to ensure the Company maintains a consistent state of Audit readiness. Maintains a current working knowledge of various laws, regulations, and industry guidance that impacts the health industry generally, and government programs in the health sector specifically, including fraud and abuse and anti-kickback statutes, OIG and government health plan guidelines and state marketing compliance laws, prompt pay, provider adequacy and other laws. Performs other duties as assigned. Complies with all policies and standards. Education/Experience: Bachelor's Degree in Business Administration, Public Policy, Public Health, Health Administration, related field, or equivalent experience required. Master's Degree CPA, CISA, JD, MHA, MBA, MIS or equivalent experience preferred 10+ years Compliance experience, preferably in a healthcare environment, or equivalent experience preferred 4+ years Management experience preferred 4+ years' Experience with risk adjustment processes, procedures, and oversight of same preferred Licenses/Certifications: HCCA certification (CHC) or equivalent preferred Pay Range: $145,100.00 - $268,800.00 per year 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

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 role will have the flexibility to work remotely anywhere in Continental United States. Position Purpose: Provides strategic leadership and management of department overseeing compliance with regulations and laws related to Risk Adjustment across our Marketplace, Medicaid and Medicare lines of business, which includes implementation of elements of an effective compliance program. Oversee the development of risk assessments oversight and the monitoring work plans pertaining to Risk Adjustment. Partners with business areas to ensure and implement effective prevention, detection and correction of compliance issues. Establishes and maintains a process for overseeing compliance with regulations and laws related to Risk Adjustment requirements. Provides guidance to various business departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contractual language. Conducts compliance reviews and manages team that conducts compliance reviews, assisting with identification of issues and collaborating with Corrections team for remediation of issues. Performs risk assessments and report emerging trends, deficiencies and variances, report findings to other departments and teams as appropriate. Ensure sufficient monitoring activities to assist with prevention and proactive identification of compliance concerns. Develops and monitors metrics and other oversight tools that indicate business area compliance. Provides compliance guidance, direction, and compliance risk assessment to assigned business partners. Plans and collaborates with other teams and leaders on complex projects/programs necessitating the origination and application of new and unique approaches. Sets operational priorities including the development and maintenance of effective oversight activities and prioritization of work. Responsible for Board and Executive reporting related to responsibilities of the team and compliance of business operations for which you oversee. Educates, encourages, and assists those within the company to maintain integrity through correction of identified non-compliance in order to meet the requirements of Government-sponsored health care programs. Participates in mock and actual CMS and other regulatory audits and coordinates with Internal Audit, Regulatory Compliance and/or Market based Regulatory Affairs on responses to agency inquiries and oversees the internal and external processes required to ensure the Company maintains a consistent state of Audit readiness. Maintains a current working knowledge of various laws, regulations, and industry guidance that impacts the health industry generally, and government programs in the health sector specifically, including fraud and abuse and anti-kickback statutes, OIG and government health plan guidelines and state marketing compliance laws, prompt pay, provider adequacy and other laws. Performs other duties as assigned. Complies with all policies and standards. Education/Experience: Bachelor's Degree in Business Administration, Public Policy, Public Health, Health Administration, related field, or equivalent experience required. Master's Degree CPA, CISA, JD, MHA, MBA, MIS or equivalent experience preferred 10+ years Compliance experience, preferably in a healthcare environment, or equivalent experience preferred 4+ years Management experience preferred 4+ years' Experience with risk adjustment processes, procedures, and oversight of same preferred Licenses/Certifications: HCCA certification (CHC) or equivalent preferred Pay Range: $145,100.00 - $268,800.00 per year 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

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 role will have the flexibility to work remotely anywhere in Continental United States. Position Purpose: Provides strategic leadership and management of department overseeing compliance with regulations and laws related to Risk Adjustment across our Marketplace, Medicaid and Medicare lines of business, which includes implementation of elements of an effective compliance program. Oversee the development of risk assessments oversight and the monitoring work plans pertaining to Risk Adjustment. Partners with business areas to ensure and implement effective prevention, detection and correction of compliance issues. Establishes and maintains a process for overseeing compliance with regulations and laws related to Risk Adjustment requirements. Provides guidance to various business departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contractual language. Conducts compliance reviews and manages team that conducts compliance reviews, assisting with identification of issues and collaborating with Corrections team for remediation of issues. Performs risk assessments and report emerging trends, deficiencies and variances, report findings to other departments and teams as appropriate. Ensure sufficient monitoring activities to assist with prevention and proactive identification of compliance concerns. Develops and monitors metrics and other oversight tools that indicate business area compliance. Provides compliance guidance, direction, and compliance risk assessment to assigned business partners. Plans and collaborates with other teams and leaders on complex projects/programs necessitating the origination and application of new and unique approaches. Sets operational priorities including the development and maintenance of effective oversight activities and prioritization of work. Responsible for Board and Executive reporting related to responsibilities of the team and compliance of business operations for which you oversee. Educates, encourages, and assists those within the company to maintain integrity through correction of identified non-compliance in order to meet the requirements of Government-sponsored health care programs. Participates in mock and actual CMS and other regulatory audits and coordinates with Internal Audit, Regulatory Compliance and/or Market based Regulatory Affairs on responses to agency inquiries and oversees the internal and external processes required to ensure the Company maintains a consistent state of Audit readiness. Maintains a current working knowledge of various laws, regulations, and industry guidance that impacts the health industry generally, and government programs in the health sector specifically, including fraud and abuse and anti-kickback statutes, OIG and government health plan guidelines and state marketing compliance laws, prompt pay, provider adequacy and other laws. Performs other duties as assigned. Complies with all policies and standards. Education/Experience: Bachelor's Degree in Business Administration, Public Policy, Public Health, Health Administration, related field, or equivalent experience required. Master's Degree CPA, CISA, JD, MHA, MBA, MIS or equivalent experience preferred 10+ years Compliance experience, preferably in a healthcare environment, or equivalent experience preferred 4+ years Management experience preferred 4+ years' Experience with risk adjustment processes, procedures, and oversight of same preferred Licenses/Certifications: HCCA certification (CHC) or equivalent preferred Pay Range: $145,100.00 - $268,800.00 per year 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

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 role will have the flexibility to work remotely anywhere in Continental United States. Position Purpose: Provides strategic leadership and management of department overseeing compliance with regulations and laws related to Risk Adjustment across our Marketplace, Medicaid and Medicare lines of business, which includes implementation of elements of an effective compliance program. Oversee the development of risk assessments oversight and the monitoring work plans pertaining to Risk Adjustment. Partners with business areas to ensure and implement effective prevention, detection and correction of compliance issues. Establishes and maintains a process for overseeing compliance with regulations and laws related to Risk Adjustment requirements. Provides guidance to various business departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contractual language. Conducts compliance reviews and manages team that conducts compliance reviews, assisting with identification of issues and collaborating with Corrections team for remediation of issues. Performs risk assessments and report emerging trends, deficiencies and variances, report findings to other departments and teams as appropriate. Ensure sufficient monitoring activities to assist with prevention and proactive identification of compliance concerns. Develops and monitors metrics and other oversight tools that indicate business area compliance. Provides compliance guidance, direction, and compliance risk assessment to assigned business partners. Plans and collaborates with other teams and leaders on complex projects/programs necessitating the origination and application of new and unique approaches. Sets operational priorities including the development and maintenance of effective oversight activities and prioritization of work. Responsible for Board and Executive reporting related to responsibilities of the team and compliance of business operations for which you oversee. Educates, encourages, and assists those within the company to maintain integrity through correction of identified non-compliance in order to meet the requirements of Government-sponsored health care programs. Participates in mock and actual CMS and other regulatory audits and coordinates with Internal Audit, Regulatory Compliance and/or Market based Regulatory Affairs on responses to agency inquiries and oversees the internal and external processes required to ensure the Company maintains a consistent state of Audit readiness. Maintains a current working knowledge of various laws, regulations, and industry guidance that impacts the health industry generally, and government programs in the health sector specifically, including fraud and abuse and anti-kickback statutes, OIG and government health plan guidelines and state marketing compliance laws, prompt pay, provider adequacy and other laws. Performs other duties as assigned. Complies with all policies and standards. Education/Experience: Bachelor's Degree in Business Administration, Public Policy, Public Health, Health Administration, related field, or equivalent experience required. Master's Degree CPA, CISA, JD, MHA, MBA, MIS or equivalent experience preferred 10+ years Compliance experience, preferably in a healthcare environment, or equivalent experience preferred 4+ years Management experience preferred 4+ years' Experience with risk adjustment processes, procedures, and oversight of same preferred Licenses/Certifications: HCCA certification (CHC) or equivalent preferred Pay Range: $145,100.00 - $268,800.00 per year 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

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 role will have the flexibility to work remotely anywhere in Continental United States. Position Purpose: Provides strategic leadership and management of department overseeing compliance with regulations and laws related to Risk Adjustment across our Marketplace, Medicaid and Medicare lines of business, which includes implementation of elements of an effective compliance program. Oversee the development of risk assessments oversight and the monitoring work plans pertaining to Risk Adjustment. Partners with business areas to ensure and implement effective prevention, detection and correction of compliance issues. Establishes and maintains a process for overseeing compliance with regulations and laws related to Risk Adjustment requirements. Provides guidance to various business departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contractual language. Conducts compliance reviews and manages team that conducts compliance reviews, assisting with identification of issues and collaborating with Corrections team for remediation of issues. Performs risk assessments and report emerging trends, deficiencies and variances, report findings to other departments and teams as appropriate. Ensure sufficient monitoring activities to assist with prevention and proactive identification of compliance concerns. Develops and monitors metrics and other oversight tools that indicate business area compliance. Provides compliance guidance, direction, and compliance risk assessment to assigned business partners. Plans and collaborates with other teams and leaders on complex projects/programs necessitating the origination and application of new and unique approaches. Sets operational priorities including the development and maintenance of effective oversight activities and prioritization of work. Responsible for Board and Executive reporting related to responsibilities of the team and compliance of business operations for which you oversee. Educates, encourages, and assists those within the company to maintain integrity through correction of identified non-compliance in order to meet the requirements of Government-sponsored health care programs. Participates in mock and actual CMS and other regulatory audits and coordinates with Internal Audit, Regulatory Compliance and/or Market based Regulatory Affairs on responses to agency inquiries and oversees the internal and external processes required to ensure the Company maintains a consistent state of Audit readiness. Maintains a current working knowledge of various laws, regulations, and industry guidance that impacts the health industry generally, and government programs in the health sector specifically, including fraud and abuse and anti-kickback statutes, OIG and government health plan guidelines and state marketing compliance laws, prompt pay, provider adequacy and other laws. Performs other duties as assigned. Complies with all policies and standards. Education/Experience: Bachelor's Degree in Business Administration, Public Policy, Public Health, Health Administration, related field, or equivalent experience required. Master's Degree CPA, CISA, JD, MHA, MBA, MIS or equivalent experience preferred 10+ years Compliance experience, preferably in a healthcare environment, or equivalent experience preferred 4+ years Management experience preferred 4+ years' Experience with risk adjustment processes, procedures, and oversight of same preferred Licenses/Certifications: HCCA certification (CHC) or equivalent preferred Pay Range: $145,100.00 - $268,800.00 per year 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

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 role will have the flexibility to work remotely anywhere in Continental United States. Position Purpose: Provides strategic leadership and management of department overseeing compliance with regulations and laws related to Risk Adjustment across our Marketplace, Medicaid and Medicare lines of business, which includes implementation of elements of an effective compliance program. Oversee the development of risk assessments oversight and the monitoring work plans pertaining to Risk Adjustment. Partners with business areas to ensure and implement effective prevention, detection and correction of compliance issues. Establishes and maintains a process for overseeing compliance with regulations and laws related to Risk Adjustment requirements. Provides guidance to various business departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contractual language. Conducts compliance reviews and manages team that conducts compliance reviews, assisting with identification of issues and collaborating with Corrections team for remediation of issues. Performs risk assessments and report emerging trends, deficiencies and variances, report findings to other departments and teams as appropriate. Ensure sufficient monitoring activities to assist with prevention and proactive identification of compliance concerns. Develops and monitors metrics and other oversight tools that indicate business area compliance. Provides compliance guidance, direction, and compliance risk assessment to assigned business partners. Plans and collaborates with other teams and leaders on complex projects/programs necessitating the origination and application of new and unique approaches. Sets operational priorities including the development and maintenance of effective oversight activities and prioritization of work. Responsible for Board and Executive reporting related to responsibilities of the team and compliance of business operations for which you oversee. Educates, encourages, and assists those within the company to maintain integrity through correction of identified non-compliance in order to meet the requirements of Government-sponsored health care programs. Participates in mock and actual CMS and other regulatory audits and coordinates with Internal Audit, Regulatory Compliance and/or Market based Regulatory Affairs on responses to agency inquiries and oversees the internal and external processes required to ensure the Company maintains a consistent state of Audit readiness. Maintains a current working knowledge of various laws, regulations, and industry guidance that impacts the health industry generally, and government programs in the health sector specifically, including fraud and abuse and anti-kickback statutes, OIG and government health plan guidelines and state marketing compliance laws, prompt pay, provider adequacy and other laws. Performs other duties as assigned. Complies with all policies and standards. Education/Experience: Bachelor's Degree in Business Administration, Public Policy, Public Health, Health Administration, related field, or equivalent experience required. Master's Degree CPA, CISA, JD, MHA, MBA, MIS or equivalent experience preferred 10+ years Compliance experience, preferably in a healthcare environment, or equivalent experience preferred 4+ years Management experience preferred 4+ years' Experience with risk adjustment processes, procedures, and oversight of same preferred Licenses/Certifications: HCCA certification (CHC) or equivalent preferred Pay Range: $145,100.00 - $268,800.00 per year 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

US Antivirals Lead, Therapeutic Area Communications, Public Affairs United States - California - Foster City Gilead Sciences, Inc. is a research-based bio-pharmaceutical company that discovers, develops and commercializes innovative medicines in areas of unmet medical need. With each new discovery and investigational drug candidate, we seek to improve the care of patients living with life-threatening diseases around the world. Gilead's therapeutic areas of focus include HIV/AIDS, liver diseases, cancer and inflammation, and serious respiratory and cardiovascular conditions. Making an impact on a global scale Inclusion is one of the company's five core values. That's because we know that we are stronger and more innovative at Gilead when we are informed by a diverse set of backgrounds, experiences and points of view. Gilead Sciences is a biopharmaceutical company that discovers, develops and commercializes innovative therapeutics in areas of unmet medical need. The company's mission is to advance the care of patients suffering from life-threatening diseases worldwide. When you join Gilead, you join our mission to change the world by enabling people to live healthier and more fulfilling lives. Come join a mission-driven bio-pharmaceutical organization that values inclusion and diversity, has a strong portfolio of products, and is constantly #CreatingPossible Gilead Sciences, Inc. is a research-based biopharmaceutical company founded in 1987. Together we deliver life-saving therapies to patients in need. With the commitment and drive you bring to the workplace every day, you will be part of a team that is changing the world and helping millions of people live healthier, more fulfilling lives. Our worldwide staff is a close community where you can see the tangible results of your contributions, where every individual matters, and everyone has a chance to enhance their skills through ongoing development. Our scientific focus has resulted in marketed products that are benefiting millions of people, a pipeline of late-stage drug candidates, and unmatched patient access programs to ensure medications are available to those who could otherwise not afford them. By joining Gilead, you will further our mission to address unmet medical needs and improve life by advancing the care of patients with life-threatening diseases. US Antivirals Lead, Therapeutic Area Communications, Public Affairs Reporting to the Executive Director, Global Therapeutic Area Communications - HIV, this role will lead US communications across the company's portfolio of antivirals in the HIV, HCV and HBV therapeutic areas. The person in this newly-created position is responsible for helping to maintain Gilead's leadership in antivirals, articulating Gilead's vision for continued innovation in the treatment of chronic viral infections and the elimination of HCV, raising awareness of unmet medical needs that our science and programs seek to address, and communicating progress against these goals. This role works closely with Gilead's Clinical Development, Commercial, Medical Affairs and Government Affairs teams to ensure communications initiatives support the achievement of corporate and business objectives. The role also engages with colleagues across Public Affairs' global centers of expertise to help inform cross-functional priorities and drive tailored implementation at a local level. Position Description Responsibilities include: Engage with leaders in the U.S. Commercial Organization, Clinical Development, Medical Affairs, Government Affairs, Regulatory Affairs and Legal as part of key cross-functional teams to drive strategy and tactical plans that shape understanding of Gilead's antiviral products and their impact on people living with or at risk of HIV, HCV or HBV Develop and roll out comprehensive narratives on Gilead's research and development, corporate development, commercialization, patient advocacy and community support efforts across these therapeutic areas Drive communications and engagement programs that raise awareness of the availability and appropriate use of Gilead's approved medicines, including data and regulatory milestone communications and disease awareness programs Lead launch communications planning and implementation for Gilead's late-stage pipeline products Lead cross-functional efforts to horizon scan and proactively address emerging issues Support product introductions with globally aligned messages and outreach Inform priorities and collaborate on antiviral programs and content in other Public Affairs centers of expertise, including corporate communications, community engagement and corporate giving. Programs may include corporate website and intranet content development, advocacy group engagement, funding opportunity announcements, among others Maintain relationships with key top-tier and trade reporters to shape reporting on Gilead's antiviral portfolio Manage PR agency partners, providing agency teams with appropriate information and oversight to effectively implement programs in compliance with Gilead's business conduct policies Manage budgets to target, ensuring appropriate investment in priority work and identifying ways to optimize resources Knowledge, Experience and Skills: BA degree in communications, liberal arts, business or science-oriented field and 14+ years of relevant experience in healthcare communications Demonstrated experience driving communications plans that support business priorities Expertise in media relations and issues management Ability to interact with senior management, academic experts and patient advocates appropriately, with confidence and ease Ability to influence others and drive alignment across diverse teams A passion for engaging in public health and policy issues Adept at understanding scientific data. Prior experience in antivirals communications is preferred In-depth understanding of the US market access environment is required. Experience working outside of the US is a plus Demonstrated knowledge of regulations governing communications for a publicly-traded biopharmaceutical company As an equal opportunity employer, Gilead Sciences Inc. is committed to a diverse workforce. In order to ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Era Veterans' Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact for assistance. For more information about equal employment opportunity protections, please view the EEO is the Law poster. #LI-LM1 We are an equal opportunity employer. Apply online today at . For jobs in the United States: As an equal opportunity employer, Gilead Sciences Inc. is committed to a diverse workforce. Employment decisions regarding recruitment and selection will be made without discrimination based on race, color, religion, national origin, gender, age, sexual orientation, physical or mental disability, genetic information or characteristic, gender identity and expression, veteran status, or other non-job related characteristics or other prohibited grounds specified in applicable federal, state and local laws. In order to ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Era Veterans' Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact for assistance. For more information about equal employment opportunity protections, please view the 'EEO is the Law' poster. NOTICE: EMPLOYEE POLYGRAPH PROTECTION ACT YOUR RIGHTS UNDER THE FAMILY AND MEDICAL LEAVE ACT PAY TRANSPARENCY NONDISCRIMINATION PROVISION Our environment respects individual differences and recognizes each employee as an integral member of our company. Our workforce reflects these values and celebrates the individuals who make up our growing team. Gilead provides a work environment free of harassment and prohibited conduct. We promote and support individual differences and diversity of thoughts and opinion. For Current Gilead Employees and Contractors: Please log onto your Internal Career Site to apply for this job. Copyright ©2017 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-1180e8cae4023f458fa08ab14ca2411c