Compliance Consultant - Remote

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

The Compliance Consultant is an individual contributor role responsible for supporting all aspects of the compliance program with focus on health plan and care delivery organization compliance program administration.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Establish effective working relationships and build credibility within the CDO and Operations to support a culture of ethics and compliance
• Partner with Optum legal counsel on matters impacting the CDO and Operations as appropriate
• Deliver targeted compliance training and communications
• Participate in the annual compliance risk survey to identify areas of material compliance risk to the business
• Develop/maintain product, regulatory, and operational knowledge for assigned businesses, with particular focus on provider practice standards and regulatory requirements
• Oversee implementation of remediation and corrective action plans, resulting from audits, investigations, compliance reviews, and self-identified issues
• Support all audit and survey activities impacting the CDO and Operations, including internal assessment activity as well as external audits from health plan partners and state and federal agencies
• Support the implementation of a compliance workplan within the CDO and Operations to mitigate any risk identified through the annual or ongoing risk assessment process
• Complete a monthly dashboard for each business supported providing a current status of key compliance indicators
• Collaborate across Optum Compliance teams, as needed
• Managing the implementation and ongoing effectiveness of the Optum Compliance Program at the assigned organization
• Coordinate with Privacy Office as needed
• Conduct compliance reviews of marketing materials, regulated documents and other external materials
• Work collaboratively with CDO, Operations and leadership in compliance and ethics program implementation
• Report to CDO and Operations leadership on compliance matters on a routine basis
• Track all compliance activities / issues within the Compliance tracker tool
• Represent Optum at the health plan Compliance Committee, which provides a venue for discussion of identified risk areas, areas of non-compliance or potential risk and non-compliance. Collaborate with health plan and business subject matter experts to develop appropriate content for the committee meetings
• General duties and responsibilities encompass implementing and supporting appropriate systems, policies and processes designed to ensure compliance with Federal and State healthcare program requirements at the health plan, care delivery organization (CDO), and supporting functional business areas
• Oversee and review operational policy and procedure development as needed
• Assist with the development of auditing, monitoring and oversight processes related to identified risks
• Conduct compliance assessments as appropriate
• Provide subject matter expertise to the Optum Investigations team on reports of noncompliance, received via ethics hotline or otherwise
• Among the specific responsibilities and activities are the following:
  
  • Work collaboratively with CDO, Operations and leadership in compliance and ethics program implementation
  • Establish effective working relationships and build credibility within the CDO and Operations to support a culture of ethics and compliance
  • Provide subject matter expertise to the Optum Investigations team on reports of noncompliance, received via ethics hotline or otherwise
  • Provide Medicare Advantage/Plan Sponsor advisory and remediation support services, as appropriate
  • Actively monitor completion status for all required compliance training modules
  • Partner with Optum legal counsel on matters impacting the CDO and Operations as appropriate
  • Participate in the annual compliance risk survey to identify areas of material compliance risk to the business
  • Support the implementation of a compliance workplan within the CDO and Operations to mitigate any risk identified through the annual or ongoing risk assessment process
  • Assist with the development of auditing, monitoring and oversight processes related to identified risks
  • Support all audit and survey activities impacting the CDO and Operations, including internal assessment activity as well as external audits from health plan partners and state and federal agencies
  • Oversee implementation of remediation and corrective action plans, resulting from audits, investigations, compliance reviews, and self-identified issues
  • Build relationships that encourage CDO and Operations employees, leadership, contractors and physicians to report suspected fraud or other improprieties without the fear of retaliation
  • Represent Optum at the health plan Compliance Committee, which provides a venue for discussion of identified risk areas, areas of non-compliance or potential risk and non-compliance. Collaborate with health plan and business subject matter experts to develop appropriate content for the committee meetings
  • Track all compliance activities / issues within the Compliance tracker tool
  • Complete a monthly dashboard for each business supported providing a current status of key compliance indicators
  • Report to CDO and Operations leadership on compliance matters on a routine basis
  • Develop/maintain product, regulatory, and operational knowledge for assigned businesses, with particular focus on provider practice standards and regulatory requirements
  • Coordinate with Privacy Office as needed
  • Provide counseling and support for key regulatory implementation initiatives
  • Oversee and review operational policy and procedure development as needed
  • Deliver targeted compliance training and communications
  • Conduct compliance reviews of marketing materials, regulated documents and other external materials
  • Conduct compliance assessments as appropriate
  • Collaborate across Optum Compliance teams, as needed
    
• Provide Medicare Advantage/Plan Sponsor advisory and remediation support services, as appropriate
• Provide counseling and support for key regulatory implementation initiatives
• Build relationships that encourage CDO and Operations employees, leadership, contractors and physicians to report suspected fraud or other improprieties without the fear of retaliation
• Actively monitor completion status for all required compliance training modules

You’ll 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:

• Experience with Medicare Advantage rules, including the Medicare Managed Care Manuals
• 4+ years of experience with Medicare Advantage plan regulations
• Understanding of the requirements of an effective corporate compliance program
• Demonstrated experience interfacing with executive leadership to enforce the compliance program

Preferred Qualifications:

• Proven exceptional written and verbal communication skills
• 5+ years of experience working in a health care compliance role
• Understanding of HIPAA and state privacy laws
• Demonstrated ability to assess complex problems and provide the appropriate compliance solutions
• Demonstrated ability to adapt in a dynamic and high-growth environment with objectivity and collaboration
• Experience working as a Subject Matter Expert in a large, highly-matrixed organization, working with various business segment and/or stakeholders
• 4+ years of experience in health plan (ideally Medicare Advantage or Medicare Advantage delegated entity) compliance
• Demonstrated ability to handle multiple priorities
• Proven analytical, organizational and problem solving skills
• Proven history of successful results in managing issues and driving strategic program initiatives
• Bachelor’s degree

Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island or Washington residents is $85,000 to $167,300. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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, you’ll find a far-reaching choice of benefits and incentives.

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves 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.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer 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.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.