1+ months

Health Plan Compliance Officer - New York, NY

New York, NY 10007
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  • Job Code
    860102
  • Jobs Rated
    25th
They say the only thing that stays the same is change. Nowhere is that more true than in health care, where transformation is happening with lightning speed. And UnitedHealth Group is leading from the front, shaping the future of health care every single day. As Associate Director of Compliance, you will manage a team responsible for monitoring changes with internal laws and regulations to ensure compliance with state and federal guidelines. As you help us make the health care system work better for everyone, you'll find yourself doing your life's best work.(sm)

The Health Plan Compliance Officer is a leadership role supporting all aspects of the compliance program for the health plan. As a member of the health plan Senior Leadership Team, the Health Plan Compliance Officer will provide strategic leadership partnering with various health plan leaders and matrix partners as needed to execute on issues of non-compliance or areas of identified risk(s).  The Health Plan Compliance Officer is accountable to the Health Plan Chief Executive Officer and the Board of Directors.

 

This role requires development of relationships with executive level business leaders and understanding of health plan and functional business structures. The Health Plan Compliance Officer actively collaborates with business leaders to implement the UHC Compliance Program at the health plan level, ensuring operational accountability for compliance with the obligations that govern our business through: (1) business owner accountability; (2) governance process and structure; (3) standardized processes, tools and accountabilities; and (4) clear outcome measures.

 
Primary Responsibilities:
  • Serve as key point of contact for regulatory agencies interfacing with the health plan regarding Compliance issues, Regulatory Audits and Corrective Actions
  • Develop and manage site Compliance Oversight Committee meetings and reporting to senior leadership and the Board of Directors
  • Develop and maintain an effective Compliance Program, including compliance-related policies and procedures
  • Ensure timely communication and education regarding the Compliance Program
  • Coordinate and support implementation of Compliance training and educational programs with the appropriate business areas
  • Oversee health plan-level Compliance and Ethics reporting
  • Coordinate with Legal Counsel, UHC Compliance Investigations, and others as needed to conduct investigations, coordinate development and implementation of appropriate corrective action
  • Oversee all regulatory audits of the health plan, including any associated remediation and instances of non-compliance (in partnership with UHC Audit Management and Corrections teams)
  • Oversee health plan risk assessment process, including identification, mitigation and management of top risks
  • Provide input into Key Compliance Indicator (KCI) development based on health plan risk assessment (e.g. identify health plan business SMEs, serve as health plan SME for regulatory requirements)
  • Demonstrate compliance risks are proactively identified and addressed through prevention, detection, correction and monitoring strategies
  • Engage with UHC Corrections to ensure effective corrective action request process
  • Work with operational leaders to ensure understanding and communication of Plan-level regulatory contract requirements
  • Ensure that standards and processes are in place for vendors contracted by the Plan that meet regulatory and business requirements
  • Oversee the health plan Fraud, Waste and Abuse program and ensure that the Plan has established processes and procedures to meet regulatory and contract requirements relating to receipt; investigation; resolution; and reporting of fraud and abuse (in partnership with UHC Program Integrity)
  • Coordinate privacy related activities with the UHC Privacy Office to ensure issue resolution occurs as appropriate and training and education is provided to Plan employees and others as required
  • Communicate regulatory changes and partner with Health Plan and matrix teams for implementation
  • Supports the health plan's response to program changes and opportunities, including business development initiatives
  • Perform other duties as assigned
 

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.



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Jobs Rated Reports for Compliance Officer

Posted: 2020-02-19 Expires: 2020-04-20

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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Health Plan Compliance Officer - New York, NY

UnitedHealth Group
New York, NY 10007

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Compliance Officer
25th2018 - Compliance Officer
Overall Rating: 25/220
Median Salary: $67,870

Work Environment
Very Good
22/220
Stress
Very Low
2/220
Growth
Poor
176/220
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