Maintain knowledge of current and impending regulations and legislation Triage and lead cross-functional teams for the implementation of complex new or existing regulatory issues, monitor, and communicate status Participate in the development of strategy in accordance with business goals for regulatory engagement and operations Provide regulatory interpretation to internal stakeholders, develop and manage work plans to meet company goals, including periodic monitoring and reporting, for adherenc... more details
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.
Manages regulatory activities and projects in support of company strategies, departments, programs, and functional areas. In cooperation with department leadership, conducts research, develops work plans and action steps and carries them through to meet internal stakeholders expectations. Stays current with regulatory requirements. Provides regulatory interpretation to internal stakeholders, performs audits, develops reports and tools to support compliance with regulatory requirements, contractual commitments, and accreditation expectations. Cooperates with management, collaborates with cross-functional teams, and monitors implementation of corrective measures. Knowledge of Federal and State regulations applicable to health plans and IPAs required. Reports to Executive Director, DMHC Engagement and Operations.
Youll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
- Maintain knowledge of current and impending regulations and legislation
- Triage and lead cross-functional teams for the implementation of complex new or existing regulatory issues, monitor, and communicate status
- Participate in the development of strategy in accordance with business goals for regulatory engagement and operations
- Provide regulatory interpretation to internal stakeholders, develop and manage work plans to meet company goals, including periodic monitoring and reporting, for adherence to regulatory requirements
- Serve as a conduit between regulators and operations, interprets requirements, centralize responses, create exhibits and reports, annual, routine, and ad-hoc under the oversight of leadership
- Provide regulatory expertise and guidance to internal stakeholders, answer questions with operationally relevant research and information
- Collaborate with various departments, and committees; assist in ensuring accurate and consistent understanding of applicable laws, present information and advice in accordance with regulatory requirements and initiatives
- Support and or develop responses to contracted health plans and regulatory authorities
- Serve as the point of contact and coordinate participation in regulatory agency audits and site visits
- Translate highly complex concepts in ways that can be understood by a variety of audiences
- Ensure policies and procedures language and format are current with applicable laws and regulations and conform to CMS, DMHC, DHCS, and NCQA expectations for language (including citation of required regulations, rules and standards, and confirmation of alignment of procedures with requirements)
- Develop and provide training on regulatory requirements
- Monitor grant performance; liaison to community agencies for programs reducing cost of care for senior members
- Resolve highly complex business problems that affect clinical and operational processes and functional requirements
- Prepare documents and develop Executive level updates and reports
- Identify cost-effective opportunities and initiate innovative recommendations for cross-functional/cross CDO process improvements
- Support other functions and duties as assigned
Youll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
- 5+ years with health care regulatory and compliance matters, current knowledge of managed care operations and industry drivers
- 3+ years of direct experience leading designing, coordinating, and implementing complex work plans with short timelines and involving multiple contributors
- Proven ability to drive cross-functional teams to deliver operational compliance
- Excellent relationship building skills and ability to lead change through influence
- Able to accommodate and manage ambiguity, to work on abstract problems across functional areas and conceptualize/implement solutions
- Ability to multi-task in a fast-paced, rapidly changing environment
- Ability to read and interpret documents such as CMS, DMHC, DHCS rules and regulations, policy and procedure manuals
- Ability to speak effectively before groups of customers or employees of the organization
- Proven ability to think strategically and to translate strategic directives into tactical initiatives
- Adept at understanding complex concepts and situations presented by the business environment
- Objective, collaborative approach. Ability to adapt in a dynamic and high-growth environment
- Superior analytical, organizational, and problem solving skills
- Experience managing multiple projects/tasks. Proven history of successful results in managing issues and driving strategic program initiatives
Preferred Qualifications:
- Managing health care regulatory and compliance matters for a Health Plan
- Supervisory experience
- Direct experience achieving compliance with DMHC, DHCS, and CMS expectations
*All employees working remotely will be required to adhere to UnitedHealth Groups Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for this role is $88,000 to $173,200 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with al minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, youll find a far-reaching choice of benefits and incentives.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyoneof every race, gender, sexuality, age, location and incomedeserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes an enterprise priority reflected in our mission.
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Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
