California Compliance Officer

Applicants for this role must live in the state of California.

About the role

Ensure regulatory compliance with state and other government agencies related to Health Net, Centene Corporation, and its business subsidiaries. Maintain and track laws, regulations, contract documentation, amendments, and various compliance measures. Develop policies, procedures, and processes to comply with state law, federal law, contract requirements, and various standards. Oversee, administer, and implement various compliance programs, including fraud and abuse and HIPAA. Provide guidance to various departments regarding compliance issues and implementation of new compliance requirements. Conduct compliance audits, develop and implement corrective action plans, and report on achievement of action plans to senior management and Board of Directors. Develop strategic relationships with state legislative policymakers and assist with the development of state legislative public policy. Identify, evaluate, and analyze the impact of state legislative and regulatory issues and advise management concerning impact. Represent senior management at various committees, meetings, and seminars.

Responsibilities

• Ensure Health Net and Centene Corporate are in compliance with state and federal program regulations, insurance regulations, regulatory requirements for business entities, and state contract requirements.
• Maintain and track laws and regulations, contract documentations, amendments, and various compliance measures.
• Develop policies, procedures, and processes to comply with state law, federal law, contract requirements, and various standards.
• Oversee, administer, and implement various compliance programs, including fraud and abuse and HIPAA.
• Provide guidance to various departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contract language.
• Conduct compliance audits, develop and implement corrective action plans, and report on achievement of action plans to senior management and Board of Directors.
• Develop strategic relationships with state legislative policymakers and assist with the development of state legislative public policy concerning state insurance, Managed Care Organization, Medicare, and Medicaid regulations and initiatives.
• Identify, evaluate, and analyze the impact of state legislative and regulatory issues and advise management concerning impact.
• Represent senior management at various committees, meetings, and seminars.
• Perform other duties as assigned.
• Comply with all policies and standards.

Requirements

• Bachelor's Degree in Public Policy, Government Affairs, Business Administration, or related field required.
• Master's Degree or Law degree preferred.
• 8+ years of compliance program management and contract experience required.
• Extensive knowledge of state administrative code and regulations, state insurance laws and regulations including managed care regulations.
• Experience with state and federal government agencies, accreditation bodies, participating provider agreements, HIPAA and Third Party Administration (TPA) laws, credentialing regulations, and prompt pay laws.
• Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope, and skill reflective of the level of this position.

Pay

$188,900.00 - $359,800.00 per year

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• 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.