Director - Value-Based Care - Compliance

RXinsider LTD.; Eden Prairie (MN); Hybrid; USD 135,000 - 231,000; Full time

Job summary

Optum is seeking a Director of VBC Compliance to lead the compliance program for value-based care initiatives across multiple teams and partners within the organization.

The role reports to the Optum Health Vice President, Compliance and collaborates with enterprise compliance, legal, audit, and business stakeholders to mature governance, monitoring, and training programs. The position is remote within the U.S. with in-office requirements in certain markets.

Qualifications

• Bachelor's degree or higher in a related field.
• Progressive healthcare compliance experience in managed care or health plans.
• Experience supervising and developing teams.
• Experience working with senior executives and cross-functional partners.
• Excellent verbal and written communication and risk mitigation skills.

Responsibilities

• Create and oversee a comprehensive compliance strategy and risk workplan.
• Collaborate with enterprise teams to implement policies and training.
• Develop monitoring programs and annual audit plans with the audit team.
• Support investigations and disciplinary actions in partnership with HR.
• Oversee VBC operations including risk adjustment, quality, network operations.

Education

Bachelor's degree; advanced degree preferred (JD, MHA, MPH, MBA, or related field)

Job description

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The Director of VBC Compliance is responsible for leading and operationalizing Optum Health's compliance program supporting VBC initiatives across several teams and matrix partners in achieving our VBC objectives. This role directly oversees compliance activities and initiatives relayed to VBC, provider network contracting and compensation structures, risk adjustment and quality, affordability, and clinical strategies. The Director will lead day-to-day compliance operations while maturing the compliance program infrastructure, governance model, monitoring capabilities, and team structure. This is a highly cross-functional leadership role requiring expertise in managed care compliance, Anti-Kickback Statute, CMS Medicare Advantage regulations and requirements, network oversight, risk adjustment, quality, and value-based care payer contracting.

This position reports to the Optum Health Vice President, Compliance, and partners closely with other Optum Health compliance leaders, enterprise compliance teams, legal, audit, and business stakeholders.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Primary Responsibilities

• Create and implement comprehensive compliance strategy, risk assessment, and detailed compliance workplan in collaboration with enterprise compliance and business partners
• Partner with enterprise compliance teams to deliver an effective compliance program designed to detect, prevent, and correct compliance issues across Optum Health including:
  • Support annual and ongoing compliance risk assessment
  • Develop, implement, and update as needed policies, procedures, processes, and best practices with enterprise compliance team across Optum Health to promote compliance with applicable laws and contractual obligations
  • Develop, implement, and update as necessary, training, awareness and educational materials and programs to support compliance and ethics agendas with enterprise compliance team
  • Develop, implement, and update, as necessary, routine monitoring to ensure ongoing compliance with laws, regulations, policies, and procedures
  • Partner with enterprise compliance audit team to develop and oversee annual audit plan, scope of audits, and overall audit execution including subsequent corrective actions, if needed
  • Partner with enterprise compliance investigations team to enable them to conduct investigations timely and effectively and support disciplinary guidelines in partnership with the human resources team and business teams
• Oversee compliance obligations across VBC operational functions, including but not limited to:
  • Risk Adjustment
  • Quality
  • VBC & payer strategy
  • Network operations
  • Healthcare economics
  • Medical expense management
  • Provider experience & engagement
  • Clinical value & affordability
• Manage and develop a team of compliance professionals, including performance management, coaching, employee development, and workload prioritization

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

• Bachelor's degree; advanced degree preferred (JD, MHA, MPH, MBA, or related field)
• 7+ years of progressive healthcare compliance experience within managed care, health plans, delegation oversight, Third Party Administrators, healthcare consulting, or law firm environments
• 5+ years of experience supervising and leading a team including performance management and talent development
• Experience working with and problem solving with senior executives and a proactive executive with a proven history of driving results in a heavily matrixed environment
• Proven solid verbal and written communication skills and an ability to seek to understand new business proposals, identify risks, and propose risk mitigation solutions

Preferred Qualifications

• CPA, CHC, CCEP, or other relevant certifications
• Experience with Medicare Advantage, Medicaid, and/or Commercial health plan and compliance programs including practical application of OIG and CMS Managed Care Manual Chapter 21 requirements and FDR requirements
• Experience working with key healthcare laws and regulations: Medicare Advantage and Medicaid regulations and manuals, False Claims Act, Anti-kickback Statute, and Stark Law
• All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $134,600 to $230,800 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline:

This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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