Regulatory Affairs Consultant - DMHC Medical Survey Readiness - Remote

UnitedHealth Group; Irvine (CA); Remote; USD 92,000 - 164,000; Full time

Job summary

UnitedHealth Group is seeking a Regulatory Affairs Consultant, DMHC Medical Survey Readiness to lead DMHC survey readiness across Optum's California licensed health plans. You will develop and execute a comprehensive readiness program, guide regulatory responses, and drive remediation to ensure Knox-Keene compliance.

Reporting to the Director, DMHC Affairs, you will collaborate with Utilization Management, Quality Management, Network Management, Compliance, Clinical Operations, and executive

Qualifications

• 5+ years of experience in health plan regulatory affairs, regulatory compliance, quality management, accreditation, audit management, or health plan operations.
• Experience with the Knox-Keene Health Care Service Plan Act, DMHC regulations, and California health plan regulatory oversight.
• Experience preparing for, coordinating, or managing regulatory surveys, audits, examinations, or accreditation reviews.
• Experience leading enterprise-wide regulatory, audit, accreditation, or compliance initiatives involving multiple stakeholders and operational functions.
• Demonstrated ability to manage complex regulatory initiatives involving multiple workstreams, competing priorities, and executive-level stakeholders.
• Experience preparing executive leadership for regulatory reviews, audits, or examinations.
• Demonstrated ability to interpret regulatory requirements and translate them into operational action plans and process improvements.

Responsibilities

• Lead DMHC medical survey readiness activities, ensuring ongoing preparedness for routine, focused, follow-up, and ad hoc surveys.
• Serve as the central coordinator for DMHC medical surveys, regulatory reviews, and corrective action activities across Optum California licensed health plans.
• Establish, implement, and maintain a comprehensive survey readiness program, including workplans, timelines, readiness assessments, document inventories, and issue tracking.
• Coordinate the collection, review, validation, and submission of pre-onsite, onsite, and post-onsite survey documentation.
• Conduct readiness assessments, gap analyses, mock audits, and document reviews utilizing DMHC TAGs and regulatory requirements.
• Lead cross-functional survey meetings and drive accountability for readiness deliverables, corrective actions, and remediation activities.
• Monitor regulatory developments, emerging enforcement trends, and DMHC guidance to assess operational impacts and survey readiness implications.
• Identify, assess, and communicate regulatory risks associated with survey findings, operational processes, and evolving regulatory expectations.
• Partner with business and operational leaders to implement corrective actions, mitigate regulatory risks, and drive sustainable process improvements.
• Ensure consistency and standardization of survey readiness practices across all Optum California licensed health plans.
• Track and report survey findings, deficiencies, corrective action plans (CAPs), remediation activities, and closure milestones.
• Provide executive leadership with strategic reporting on survey readiness, regulatory risks, findings, corrective actions, and mitigation strategies.
• Ensure policies, procedures, committee structures, and operational processes align with Knox-Keene requirements, DMHC regulations, and health plan commitments.
• Coordinate and support regulator interviews, file reviews, entrance conferences, exit conferences, and other survey-related activities.
• Establish and maintain regulatory evidence repositories and documentation controls to support efficient survey preparation and response activities.
• Develop and deliver training and education regarding DMHC survey expectations, regulatory requirements, and readiness best practices.
• Serve as the primary liaison between the health plans and DMHC regarding survey-related inquiries, document requests, findings, and corrective action activities.
• Support additional regulatory initiatives and special projects as assigned.

Skills

Regulatory affairs

Regulatory compliance

Project management

Executive stakeholder communication

Education

RN

MPH

JD

CPHQ

CHC

Job description

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us in making healthcare work better for everyone through people-led, responsible AI while Caring. Connecting. Growing together.

The Regulatory Affairs Consultant, DMHC Medical Survey Readiness serves as the strategic lead for DMHC routine, follow-up, focused, and ad hoc medical surveys across Optum's four California licensed health plans. This role is accountable for developing and executing a comprehensive survey readiness program, providing expert regulatory guidance, directing health plan responses to regulatory reviews, and overseeing corrective action and remediation efforts to support compliance with California regulatory requirements.

Reporting to the Director, DMHC Affairs, this position serves as the primary liaison between health plan leadership, operational stakeholders, and regulatory agencies on matters related to medical surveys and regulatory readiness. The consultant partners closely with Utilization Management, Quality Management, Network Management, Customer Service, Credentialing, Compliance, Clinical Operations, and executive leadership to ensure adherence to the Knox-Keene Health Care Service Plan Act, DMHC regulations, and health plan filing commitments.

This role plays a critical part in identifying and mitigating regulatory risk, driving sustainable operational improvements, and strengthening organizational readiness in response to increasing DMHC oversight, scrutiny, and enforcement activities.

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:

• Lead DMHC medical survey readiness activities, ensuring ongoing preparedness for routine, focused, follow-up, and ad hoc surveys
• Serve as the central coordinator for DMHC medical surveys, regulatory reviews, and corrective action activities across Optum California licensed health plans
• Establish, implement, and maintain a comprehensive survey readiness program, including workplans, timelines, readiness assessments, document inventories, and issue tracking
• Coordinate the collection, review, validation, and submission of pre-onsite, onsite, and post-onsite survey documentation
• Conduct readiness assessments, gap analyses, mock audits, and document reviews utilizing DMHC Technical Assistance Guides (TAGs) and regulatory requirements
• Lead cross-functional survey meetings and drive accountability for readiness deliverables, corrective actions, and remediation activities
• Monitor regulatory developments, emerging enforcement trends, and DMHC guidance to assess operational impacts and survey readiness implications
• Identify, assess, and communicate regulatory risks associated with survey findings, operational processes, and evolving regulatory expectations
• Partner with business and operational leaders to implement corrective actions, mitigate regulatory risks, and drive sustainable process improvements
• Ensure consistency and standardization of survey readiness practices across all Optum California licensed health plans
• Track and report survey findings, deficiencies, corrective action plans (CAPs), remediation activities, and closure milestones
• Provide executive leadership with strategic reporting on survey readiness, regulatory risks, findings, corrective actions, and mitigation strategies
• Ensure policies, procedures, committee structures, and operational processes align with Knox-Keene requirements, DMHC regulations, and health plan commitments
• Coordinate and support regulator interviews, file reviews, entrance conferences, exit conferences, and other survey-related activities
• Establish and maintain regulatory evidence repositories and documentation controls to support efficient survey preparation and response activities
• Develop and deliver training and education regarding DMHC survey expectations, regulatory requirements, and readiness best practices
• Serve as the primary liaison between the health plans and DMHC regarding survey-related inquiries, document requests, findings, and corrective action activities
• Support additional regulatory initiatives and special projects 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.

Required Qualifications:

• 5+ years of experience in health plan regulatory affairs, regulatory compliance, quality management, accreditation, audit management, or health plan operations
• Experience with the Knox-Keene Health Care Service Plan Act, DMHC regulations, and California health plan regulatory oversight
• Experience preparing for, coordinating, or managing regulatory surveys, audits, examinations, or accreditation reviews
• Experience leading enterprise-wide regulatory, audit, accreditation, or compliance initiatives involving multiple stakeholders and operational functions
• Demonstrated ability to manage complex regulatory initiatives involving multiple workstreams, competing priorities, and executive-level stakeholders
• Experience preparing executive leadership for regulatory reviews, audits, or examinations
• Proven solid analytical, organizational, project management, written communication, and verbal communication skills
• Demonstrated ability to interpret regulatory requirements and translate them into operational action plans and process improvements

Preferred Qualifications:

• RN, MPH, JD, CPHQ, CHC, or other relevant professional certifications
• Experience leading or managing DMHC medical surveys, focused reviews, or regulatory examinations
• Experience developing and implementing survey readiness, regulatory preparedness, or compliance monitoring programs
• Experience with DMHC Technical Assistance Guides (TAGs), corrective action plans, and remediation activities
• Experience supporting full-service, restricted, or limited Knox-Keene licensed health plans
• Experience with NCQA, CMS, DHCS, URAC, or other regulatory, accreditation, or oversight reviews

*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 $91,700 - $163,700 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 help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.

UnitedHealth Group and its affiliated brands are 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 and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.