Compliance Oversight Specialist

7 days ago

HONOLULU, United States Ohana Health Plan Full time

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.

Position is remote but Candidate must reside in Hawaii and be able to attend

occasional meetings at Honolulu-820 Mililani St, Ste 200

Position Purpose: With the Ohana Health Plan Compliance Team in Hawaii, you will participate in the oversight of the Ohana Health Plan's compliance program.

  • Creating and conducting audits and monitoring activities based on identified risk.
  • Communication with the state Medicaid agency and the Medicaid Fraud Control Unit.
  • Assists Markets (local), Shared Services (corporate), and/or delegated subcontracts in the identification and assessment of compliance risks.
  • Managing and ensuring timely completion and submission of reporting deliverables.
  • Understanding and interpreting the Medicaid and DSNP contracts as well as State and Federal law.
  • Assist in managing the Compliance work and audit plan.
  • Participates in special projects as needed, including training.
  • Complies with all policies and standards

Required Education and Experience:
Required: Bachelor's Degree in Related field OR
Associates Degree with (4) years of applicable experience OR High School Diploma/GED with (5) years of applicable experience in lieu of Bachelor’s degree

Candidate Experience:

Required (3+) years of experience in Managed Care/Health Insurance with Bachelor's Degree.

Preferred Skills:

Preferred 1+ year of experience in project oversight type role with demonstrated ability to drive implementation and influence others
Preferred 1+ year of experience in reading, analyzing, and interpreting State and Federal laws, rules and regulations
Preferred 1+ year of experience in State Medicaid or Federal managed care compliance

Licenses and Certifications: A license in one of the following is required: Preferred Other Certified in HealthCare Compliance (CHC)

Pay Range: $54,000.00 - $97,100.00 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. Total compensation may also include additional forms of incentives.

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.

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