1+ months

Director of Compliance - El Segundo CA Ontario CA Irvine CA - 907189

El Segundo, CA 90245
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  • Job Code
    907189

Optum, part of the UnitedHealth Group family of companies, is looking for an experienced Director of Compliance to join our dynamic Compliance team. Things are exciting at Optum as we are experiencing unprecedented growth, especially within California.

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The Director is responsible for supporting all aspects of the compliance program for Optum's California care delivery operations, including legacy HealthCare Partners, Monarch, NAMM, and Applecare and all affiliated medical groups, networks and multiple limited and/or restricted Knox Keene licenses. The Director will oversee other team members to effectuate compliance program administration and will provide strategic compliance advice to leadership within the context of all relevant regulatory, compliance and operational parameters. The Director will assist in and oversee the design, implementation, and maintenance of the compliance and audit programs including policies and procedures and will assist in ensuring adequate internal controls and compliance with all applicable laws and regulatory requirements. Ideal candidates will have direct experience in provider/clinical/hospital operations, along with a compliance and/or legal background.

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Primary Responsibilities:

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  • Manage the implementation of the Optum Compliance Program for Optum California including any affiliate relationships, acquisitions and Knox Keene licenses
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  • Provide guidance on delegated function oversight, including dashboard development
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  • Assist in enhancing metrics related to delegation oversight to ensure compliance with regulatory and plan requirements
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  • Respond to complex operational challenges with innovative solutions supported by understanding and managing the complex regulatory filing and reporting requirements
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  • Assist with strategic initiatives to provide standardized advice and support for health plan requests and audits
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  • Ensure implementation of Optum systems, processes and policies designed to ensure compliance with Federal healthcare program requirements for medical groups and any state regulatory requirements
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  • Advise the CA care delivery organization (CDO) leadership on issues concerning compliance and ethics matters including recommending controls designed to ensure compliance
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  • Work collaboratively with CDO leadership in compliance and ethics program development and implementation
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  • Establish effective working relationships and build credibility within the CDO to support a culture of ethics and compliance
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  • Interface directly with employees and serve as a sounding board for their concerns about ethics and compliance matters
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  • Provide subject matter expertise to the Optum Investigations team on reports of noncompliance, received via ethics hotline or otherwise
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  • Ensure dissemination and access for all staff to compliance policies and procedures and the UHG Code of Conduct
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  • Partner with Optum legal counsel on matters impacting CDO as appropriate
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  • Conduct an annual risk survey to identify areas of material compliance risk to the business. Assist with the development of auditing, monitoring and oversight processes related to identified risks
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  • Oversee the implementation of corrective action plans and monitoring in response to identified issues and audits
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  • Develop monitoring systems and processes for compliance issues
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  • Build relationships that encourage employees, leadership, contractors and physicians to report suspected fraud or other improprieties without the fear of retaliation
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  • Ensure effective compliance governance via committees or meetings, as appropriate
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  • Implement the OptumCare compliance work plan and initiatives and systems to prevent compliance issues from arising
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  • Report to leadership on compliance matters on a routine basis
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  • Advise and consult on compliance and ethics matters
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  • Develop / maintain product, regulatory, and operational knowledge for assigned businesses, with focus on provider practice standards and regulatory requirements
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  • Coordinate with Privacy Office as needed
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  • Provide counseling and support for key regulatory implementation initiatives
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  • Oversee and review operational policy and procedure development as needed
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  • Deliver targeted and/or live compliance training and communications
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  • Conduct and/or provide subject matter expertise for compliance, assessments, audits and reviews
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  • Oversee remediation and corrective action plans, resulting from audits, investigations, compliance reviews, and self-identified issues
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  • Conduct compliance reviews of marketing materials, regulated documents and other external materials
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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:

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  • Bachelor's degree
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  • 5+ years of experience working in a regulatory and / or compliance role
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  • 5+ years of experience working in provider and clinical operations in a compliance or administrative role
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  • Understanding of HIPAA and state privacy laws
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  • Understanding of CMS and California Department of Managed Health Care (DMHC) Knox Keene regulations
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  • Strong project management experience and ability to handle multiple priorities
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  • Experience working as a subject matter expert in a large, highly matrixed organization, working with various business segments and / or stakeholders
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  • You will be asked to perform this role in an office setting or other company location.
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  • Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained.
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Preferred Qualifications:

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  • Post-graduate degree
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  • Ability to think strategically and to translate strategic directives into tactical initiatives
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  • Ability to drive cross-functional teams to deliver operational compliance
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  • Adept at understanding complex concepts and situations presented by the business environment
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  • Ability to assess complex problems and provide the appropriate compliance solutions
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  • Objective, collaborative approach. Ability to adapt in a dynamic and high-growth environment
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  • Exceptional written and verbal communication skills
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  • Superior analytical, organizational, and problem-solving skills
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  • Persuasive presentation and communication skills with ability to present to executive leadership and board members
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  • Comfortable working through ambiguity and able to multi-task successfully
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  • Experience managing and leading teams
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Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

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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.

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Job Keywords: director of compliance, compliance officer, El Segundo, Ontario, Irvine, California, CA

Posted: 2021-01-22 Expires: 2021-03-06

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Director of Compliance - El Segundo CA Ontario CA Irvine CA - 907189

UnitedHealth Group
El Segundo, CA 90245

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