Manager, Third Party Risk Management (Clinical_RN))

About the role

Provides clinical oversight of the organization's third-party risk management program. Manages and oversees activities to independently and objectively assess third party/subcontractor compliance with company standards, Federal and State requirements and, where applicable, additional program standards such as National Committee for Quality Assurance (NCQA) Accreditation. Drives risk mitigation strategies, coordinates cross-functional efforts, and provides strategic insights to leadership.

Responsibilities

• Develops, implements, and maintains third party risk management framework, policies, and procedures for third parties supporting care management, population health, utilization management and other clinical operations.
• Evaluates third party compliance and performance by conducting pre-service, annual, and risk-based audits, and monitoring activities to measure performance against expectations, policies, procedures and requirements.
• Manages issue resolution by identifying issues, recommending action plans, monitoring remediation activities and reporting on corrective action plan progress.
• Collaborates with cross-functional teams (such as Operations, IT Security, Procurement, Compliance, etc.) to identify, evaluate and manage third party risks.
• Prepares and presents reports and dashboards for senior leadership and board of directors.
• Serves as a key point of contact for third parties, providing guidance on contractual and regulatory obligations, and ensuring timely communication of new or updated requirements.
• Maintains and mentors a team of individual contributors that support third party risk management processes, fostering a culture of accountability and continuous improvement.
• Allocates resources effectively to support third party risk management program activities.

Requirements

• Bachelor's Degree in Business Management, Health Administration, or related field.
• 5+ years of audit, compliance, third-party oversight and/or related experience.
• Knowledge of Medicare, Medicaid, Marketplace and health plan administration preferred.
• Project management experience in planning, coordinating and executing projects preferred.

Qualifications

• Active, unrestricted Registered Nurse (RN) upon hire.

Skills

• Strong analytical and problem-solving skills.
• Excellent communication and interpersonal skills.
• Ability to work independently and as part of a team.
• Proficiency in Microsoft Office Suite.

Benefits

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.

Pay

$87,700.00 - $157,800.00 per year

Schedule

Full-time