Position Purpose:
Provides clinical oversight of the organization's third-party risk management program. Manage and oversee 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, coordinate cross-functional efforts, and provides strategic insights to leadership.
- 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.
- Coordinates 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.
- Supports internal and external audits related to third party compliance oversight by maintaining appropriate documentation, coordinating with third parties, performing quality review of submissions, and preparing presentations to stakeholders.
- Monitors timely receipt of accurate and complete reporting for all regulatory and contractual-required reports required for the third party.
- 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.
- Manages 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.
- Performs other duties as assigned.
- Complies with all policies and standards.
Education/Experience:
Bachelor's Degree Business Management, Health Administration, or related equivalent work experience required.
5+ years Audit, Compliance, third party oversight and/or related experience required.
Knowledge of Medicare, Medicaid, Marketplace and health plan administration preferred.
Project management experience in planning, coordinating and executing projects preferred.
Licenses/Certifications:
Active, unrestricted Registered Nurse (RN) Upon Hire required
Pay Range: $87,700.00 - $157,800.00 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.
