Compliance Consultant - Telecommute

Careers at UnitedHealth Group

We're creating opportunities in every corner of the health care marketplace to improve lives while we're building careers. At UnitedHealth Group, we support you with the latest tools, advanced training and the combined strength of high caliber co-workers who share your passion, your energy and your commitment to quality. Join us and start doing your life's best work. SM


Compassion. It's the starting point for health care providers like you and it's what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you're also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life's best work. SM

Our teams are helping people from around the world. We can bring out your best as you put your listening, analytical and problem solving skills to work in a setting that is geared to helping improve lives and enhance health care for millions. Here, you'll discover a wealth of pathways for professional growth within Customer Service, Billing, Claims, Enrollment & Eligibility and across our global economy. Join us and find out why this is the place to do your life's best work. SM

Combine two of the fastest-growing fields on the planet with 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 reliable. There's no room for error. Join us and start doing your life's best work. (sm)

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 telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:
  • The compliance consultant has responsibility for managing the implementation and ongoing effectiveness of the Optum Compliance Program at the assigned care delivery organization.
  • General duties and responsibilities encompass implementing and supporting appropriate systems, policies and processes designed to ensure compliance with Federal healthcare program requirements at the care delivery organization (CDO) and for partner health plans. Work collaboratively with CDO and leadership in compliance and ethics program implementation.
  • Establish effective working relationships and build credibility within the CDO 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-related 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 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 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, 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 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 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.

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.

  • High School Diploma/GED
  • 4+ years of experience in health plan (ideally MA or MA delegated entity) compliance.
  • Experience with MA rules, including the Medicare Managed Care Manuals.
  • Understanding of the requirements of an effective corporate compliance program.
  • Understanding of HIPAA and state privacy laws.
  • Solid project management experience and ability to handle multiple priorities.
  • Experience working as a Subject Matter Expert in a large, highly matrixed organization, working with various business segment and/or stakeholders.
  • Ability to assess complex problems and provide the appropriate compliance solutions.
  • Ability to adapt in a dynamic and high-growth environment with objectivity and collaboration
  • Exceptional written and verbal communication skills.
  • Proven analytical, organizational and problem-solving skills.
  • Proven history of successful results in managing issues and driving strategic program initiatives.
  • Bachelor's degree, preferred
  • 5+ years of experience working in a health care compliance role, preferred

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. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

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.

Job Keywords: Compliance, Medicare Advantage, Hartford, CT, Connecticut, Eden Prairie, MN, Minnesota, Chicago, IL, Illinois, Telecommute, Telecommuter, Telecommuting, Work from home, work at home, remote