Centene is transforming the health of our communities one person at a time.  As an Executive on our team, you could be the one who changes everything for our 28 million members.
 

Applicants for this role will have the flexibility to work remotely anywhere in the continental United States.

Position Purpose: The VP Corporate Compliance Investigations is responsible for the initial assessment of internal allegations and reports of compliance-related complaints by internal and external parties; investigating allegations, assertions and complaints regarding compliance concerns, risks or potential violations; preparing periodic reports and, as necessary, findings and conclusions for Human Resources, Internal Audit, Legal, the senior management team and the Board Compliance Committee; and, after consulting as appropriate with Legal, reporting to federal and state agencies and other corporate functions. This position will serve as a champion for an enterprise-wide culture of compliance and will provide effective leadership and guidance to the senior management team. Must build and maintain strong collaborative working relationships across the Company and with key federal and state regulators, including the OIG and the Centers for Medicare and Medicaid Services ("CMS").

• Oversees the management of the Compliance Investigation Unit (CIU), the Ethics Point hotline and risk assessments of Centene's investigative processes.
• Provides direction for managing and evaluating internal inquiries and allegations, external complaints, and conducting investigations of ethics, and compliance matters across all business areas.
• Responds to alleged violations of rules, regulations, policies, procedures and Centene's Code of Conduct and Business Ethics by evaluating and recommending the initiation of investigative procedures.
• Develops, initiates, maintains, and revises policies, procedures, and assessment tools to ensure a consistent framework for investigations and related documentation.
• Collaborates with internal and external partners to implement appropriate policies and procedures to ensure consistency and timeliness in the investigation and disposition of allegations, complaints and reports of misconduct.
• Collaborates with other departments and business units to promote the development of cross-departmental processes to identify and mitigate compliance risk trends.
• Oversees the detection, examination, analysis and reporting of instances of potential fraud, waste and abuse no within scope of the Special Investigations Unit.
• Prepare periodic reports and, as necessary, findings and conclusions for Human Resources, Internal Audit, Legal, the senior management team and the Compliance Committee of Centene's Board of Directors.
• Perform follow-ups on Compliance investigations completed to ensure that risk has been addressed appropriately.
• Ensures appropriate and prompt investigation and resolution of regulatory complaints and interacts with federal and state regulatory agencies regarding those initiatives.
• Promotes a positive team culture ensuring that the staff is highly productive, compliant, ethical, motivated, and professional.
• Promotes the development of cross-departmental processes and collaboration.
• Manages resources conservatively; partners closely with area and functional leaders, and external resources, to achieve cost-effective processes and solutions.
• Execute responsibilities consistent with CMS, OIG and state guidance for investigations.

Education/Experience:

• Bachelor's Degree in a related field required. Master's Degree in a related field or Juris Doctor (JD) preferred.
• 10+ years of experience in leading Internal compliance investigations and implementing internal processes that enhance and encourage ethical behavior required.
• 7+ years of management experience required.
• Other Resolving Medicaid and Medicare compliance issues experience required.
• Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.

Licenses/Certifications:

• Active bar membership in at least one U.S. jurisdiction preferred.

Pay Range: $185,200.00 - $352,700.00 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, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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