Regulatory Operations Analyst III - Medicaid

Location: Remote-OR

Time Type: Full time

Job Description

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.
 

This role is remote for candidates located in the State of Oregon only with some potential travel to Salem.

Position Purpose: Reviews, interprets and summarizes proposed and enacted legislation and regulatory updates to the business as a subject matter expert on various complex topics.

• Monitoring OAR Changes: This responsibility involves tracking proposed changes to Oregon Administrative Rules (OAR), keeping subject matter experts (SMEs) updated, and collecting feedback throughout the process. It includes engaging in Rule Advisory Committees (RACs), supporting the submission of written feedback to the Oregon Health Authority (OHA), and acting as the business owner for the RLI (Regulatory Legislation Implementation) process.
• Annual Contract Restatement: The staff are expected to support the end-to-end process for the annual contract restatement, serving as the business owner. This includes monitoring all changes from the initial proposal through contract finalization and implementation, attending related meetings, collaborating with the project manager to track implementation status, and identifying and escalating risks to the Executive Sponsor. Additionally, it involves analyzing contract amendments as they occur throughout the year.
• OHP Contractor Workgroups: Support for Oregon Health Plan (OHP) contractor workgroups includes attending key meetings, sharing topics in advance, and distributing information afterward. The responsibilities also involve responding to Requests for Information (RFIs) resulting from these meetings and bringing SMEs together as needed to discuss pertinent topics.
• DFR Meetings: The staff are responsible for supporting monthly Division of Financial Regulation (DFR) meetings by attending, organizing follow-ups, and acting as the primary contact for rules, bulletins, and expectations. This includes managing communications and ensuring compliance with regulatory requirements.
• Performs other duties as assigned

• Complies with all policies and standards

Preferred Skills:

• Demonstrated ability to build and maintain effective working relationships with state regulators, particularly the Oregon Health Authority (OHA)
• Strong technical understanding of Medicaid policy, administrative rules, and regulatory guidance; prior experience working at or with OHA is a plus
• High level of attention to detail and strong organizational skills to manage complex regulatory requirements and timelines
• Ability to translate highly technical regulatory and policy language into clear, plain-language guidance and actionable recommendations for internal collaborators
• Proven ability to thoughtfully and effectively advocate for regulatory clarifications or changes when appropriate
• Strong compliance mindset, with experience ensuring organizational practices align with regulatory and contractual requirements

Education/Experience: Bachelor's degree in business, Communications, Healthcare, Political Science/Pre-Law or equivalent experience required. Master's Degree in a related field, Juris Doctorate degree may be considered in place of experience preferred
4+ year's experience in health insurance, legal, compliance or related field required
Experience reviewing regulations and providing interpretation using terms appropriate for the audience preferred
Experience in commercial health insurance and/or behavioral health managed care preferred

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