Senior Leader, Compliance | Sunshine Health

Centene Corporation

  • Location: Sunrise, FL

Grant Cooper, a healthcare executive recruiter, is seeking a Senior Leader of Compliance for Sunshine Health, a subsidiary of CentenCentene Corporation is a diversified, multi-national healthcare enterprise providing a portfolio of services to government-sponsored health care programs with a focus on under-insured and uninsured individuals. Centene works with more than 11 million members in 31 states with government-sponsored healthcare programs and initiatives. Fortune Magazine has ranked Centene Corporation No. 66 in its 2017 FORTUNE 500 list of largest corporations in the United States ranked by revenue, up from 124th spot last year.

As a wholly owned subsidiary of Centene Corporation, Sunshine Health is among the largest, comprehensive, statewide, healthcare plans in Florida. Sunshine Health offers health plan benefits to children and adults who are eligible for Florida Medicaid, dually eligible for Medicare and Medicaid, and eligible for Long Term Care. Additionally, Sunshine Health offers a specialty Medicaid health plan for children currently in or adopted from Florida’s Child Welfare/Foster Care system and a full pay Healthy Kids plans statewide, as well as offerings on Florida’s Health Insurance Marketplace.

Position Overview

Reporting to the CEO of Sunshine Health, the Senior Leader of Compliance will oversee and ensure regulatory compliance with state and other government agencies related to the health insurance industry, Centene Corporation, and its business subsidiaries. The Senior Leader will develop strategic relationships with policy makers, assist with the development of public policy, and serve as a key member of the leadership team for all compliance related issues at Sunshine Health.

Qualifications

  • Strong depth in oversight, administration, and implementation of compliance programs including Fraud and Abuse and HIPAA.
  • Extensive knowledge of administrative codes and regulations, and insurance laws and regulations including managed care regulations.
  • Experience in managing relationships with state and federal government agencies, accrediting bodies, participating provider agreements, HIPAA and Third Party Administration (TPA) laws, credentialing regulations, and prompt pay laws.
  • Thought leadership in evaluating, analyzing, and explaining the impact of state legislative and regulatory issues, and advising management on potential impact.
  • At least five years of experience in compliance program management.
  • Bachelor’s Degree required; Master’s Degree or Law Degree preferred.