Regulatory Affairs Lead – DMHC 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

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