Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)
This role supports all aspects of the clinical operational regulatory adherence and the associated operating requirements that align to the OptumCare business model. The Regulatory Adherence Consultant will provide support to clinical program leaders to execute the organizations adherence strategy. The role is responsible for supporting all efforts that ensure business processes throughout and across the organization are meeting all regulatory and contractual clinical payor requirements. This role requires the Regulatory Adherence Consultant to develop collaborative relationships with program leaders and other matrix partners.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
- Provide clear, current, consistent and accurate information on State and Federal regulatory requirements on complex issues that impact Clinical Performance
- Provide regulatory guidance and support during implementation, oversight and remediation of delegated services from health plans for Medicare Advantage, DSNP, and CSNP
- Develop and implement a protocol to monitor/review internal and external state and federal regulatory resources and publications applicable to OptumCare clinical programs; proactively communicate relevant findings to Clinical Performance program leaders
- Collaborate with Optum legal, compliance and regulatory affairs to support adherence to state, federal and payer requirements for clinical performance programs
- Provide regulatory adherence support in process development for clinical programs to ensure processes are not conflicting with regulatory requirements
- Draft, review, edit and maintain national clinical policies pertaining to patient and staff safety, utilization management, care management, disease management and delegation
- Conduct legal research (e.g. state and federal statutes, rules and regulations and accreditor requirements pertaining to UM/CM/DM)
- Communicate and collaborate with key stakeholders regarding findings and recommendations
- Serves as a key resource on complex and critical clinical program issues where regulatory, accreditor or other requirements exist
- Leverage technology to develop and deliver internal presentations and/or training on regulatory topics (e.g., PowerPoint, Teams, Visio, etc.)
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.
- Undergraduate degree in health-related or legal field, OR undergraduate degree with significant related work experience
- 5+ years of experience in clinical or health plan setting
- 5+ years of experience researching, interpreting, and applying state and federal guidance, rules, regulations, and requirements to business processes
- Deep understanding of Medicare and Medicaid (e.g. NCQA, URAC, state & federal regulatory requirements) and proficiency in researching and interpreting Medicare and Medicaid requirements
- Knowledge of Utilization Management, Case Management, and Disease Management
- Experience working on high-profile issues with proven ability to be a key contributor to resolution
- Prior experience in a paralegal or regulatory role
- Excellent verbal & written communication, presentation, and facilitation skills
- Solid team player with demonstrated interpersonal and customer service skills
- Highly organized and motivated
- Critical thinker
UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.
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)
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Colorado Residents Only: The salary range for Colorado residents is $79,700 to $142,600. 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
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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