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: Perform operational and compliance risk based audits for the health plan.
Please note: candidate must reside within the state of California.
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.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
Position Purpose: Perform operational and compliance risk based audits for the health plan.
- Develop schedule and perform health plan audits and specialty care company (subcontractor) audits for either federal or state managed care programs
- Evaluate processes and performance through audits for scalability, effectiveness, efficiency, and risk mitigation
- Provide written audit documentation regarding state and/or federal managed care programs and process audit observations
- Review and analyze responses to audit observations and findings and facilitate corrective action plans
- Facilitate Health Plan and specialty care company (subcontractor) compliance through corrective action process.
- Identify, develop and implement corrective actions and training materials to improve program performance based on audit outcomes
- Provide education and training to internal and external entities as needed on programs, compliance, and fraud, waste and abuse
- Serve as a resource related to the health plan and specialty care company (subcontractor) programs
- Performs other duties as assigned
- Complies with all policies and standards
Please note: candidate must reside within the state of California.
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.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act