Centene Corporation

  • Raleigh, NC, United States
Centene Corporation
Centene Corporation Charlotte, NC, USA
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Must live in or near Mecklenburg County! **Position Purpose:** Lead, monitor and evaluate the performance of national delegated vendors according to CMS, NCQA, Federal and State requirements. + Lead compliance audits of vendors. Identify audit scope and required audit tools. Ensure audit results are appropriated compiled and accounted for within designated audit tools + Manage, audit, and monitor both internal and external vendors against CMS, contractual, Federal, State, and NCQA standards + Review vendors documented processes against contractual, Federal, State, CMS, and NCQA standards + Identify process gaps and deficiencies and communicate audit observations, recommendations, and process...

Centene Corporation Atlanta, GA, USA
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. This is a hybrid position. The team meets in the Columbus, OH office on Wednesdays, but is able to work from home on Monday, Tuesday, Thursday, and Friday. Position Purpose: Responsible for the development and implementation of the health plan’s compliance audit work plan. Completes Prospective and retrospective audits on a monthly, quarterly and annual basis. Identify regulatory oversight deficiencies, process gaps and communicate audit observations, analyzes findings to provide recommendations on process improvements to the Chief Compliance Officer. Utilize compliance knowledge to analyze audit findings and in answering disputed findings. Develop and implement compliance improvement and...