Director, Regulatory Contract Management

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

Purpose:

Manage all contracts between Health Plan and State Regulatory Agency. Collaborate with multiple corporate entities and departments to implement regulatory requirements.

• Direct the evaluation, review, negotiations and ongoing management of product-specific contracts and amendments between Health Plan and State Regulatory Agency
• Analyze and advise management and staff regarding state and federal health care laws, including laws applicable to managed care industry, Medicare, and Medicaid plans such as licensing requirements, prompt pay, and credentialing
• File contracts and amendments with applicable parties (e.g., State Agency and Department of Insurance)
• Coordinate distribution of contracts, policy changes and the impact analyses within the company
• Perform legal research and prepare memoranda regarding legislative or regulatory changes affecting the company’s vendor and/or health care provider contracts
• Coordinate legal efforts with the Corporate Legal Department
• Develop and implement contract/policy changes and impact analyses within the plan
• Manage legal aspects of Open Records process, appeal, IRO and Fair Hearings processes between Health Plan and State Regulatory Agency
• Oversee, administer, and implement various aspects of the Medicaid Regulatory Operations/ Compliance program, including communication to/from the Medicaid Agency, Medicaid Contracts, Annual Audit, and findings from that audit
• Coordinate and document Coordinated Care's responses to Medicaid Agency Request for Information/Response
• Provide guidance to various departments regarding regulatory issues and ensure implementation of new compliance requirements with respect to regulatory and contract language
• Identify, evaluate, and analyze the impact of Medicaid and Medicare regulatory issues and advise management concerning impact
• Partner with various departments to ensure that state and/or federal regulatory requirements are communicated and met
• Maintain and track laws and regulations, contract documentations, amendments, and various compliance measures
• Performs other duties as assigned
• Complies with all policies and standards

Education/

Experience:

Bachelor's Degree in Business Administration, Healthcare Administration or related field. 7+ years of combined contract drafting and legal research experience. Knowledge of the health care industry, specifically government services and applicable laws and regulations. Knowledge of Medicare and/or Medicaid insurance, state insurance and HMO regulations preferred.

This position is remote within the state of Washington. In person meeting attendance required as needed.

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

Purpose:

Manage all contracts between Health Plan and State Regulatory Agency. Collaborate with multiple corporate entities and departments to implement regulatory requirements.

• Direct the evaluation, review, negotiations and ongoing management of product-specific contracts and amendments between Health Plan and State Regulatory Agency
• Analyze and advise management and staff regarding state and federal health care laws, including laws applicable to managed care industry, Medicare, and Medicaid plans such as licensing requirements, prompt pay, and credentialing
• File contracts and amendments with applicable parties (e.g., State Agency and Department of Insurance)
• Coordinate distribution of contracts, policy changes and the impact analyses within the company
• Perform legal research and prepare memoranda regarding legislative or regulatory changes affecting the company’s vendor and/or health care…