Associate Director Of Risk Management - Remote

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

By delivering solutions across spectrums of health care Optum is focused on our aspiration of improving experiences and outcomes for everyone we serve while reducing the total cost of care. In support of this, OptumInsight's purpose is to connect the health care system with trusted services, analytics and platforms that make clinical and administrative processes valuable, easy and efficient for everyone.

OptumInsight provides analytics, research, consulting, technology and managed services solutions to hospitals, physicians, health plans, government agencies, life science companies and other industry partners. In addition to our many commercial clients, OptumInsight capabilities and technologies are leveraged by OptumHealth, OptumRx and our sister company UnitedHealthcare.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Lead Government Case Affairs Compliance team referring annually over 1000 behavioral health case investigations related to allegations of Fraud, Waste and Abuse (FWA) to Medicaid, Medicare, and commercial payer clients according to each entity’s requirements
• Lead team that supplies annually over 400 enterprise responses to requests for information (RFIs) and subpoenas for behavioral health FWA cases
• Lead a team delivering annually 600 Medicaid, Medicare, and commercial payer client reports according to each entity’s requirements
• Continually review and revise legislative source of truth regarding referral timelines, investigation requirements, and required documentation
• Analyze annually over 500 legislative bulletins for application and implementation across supported business lines
• Owns end to end process of PNI regulatory reporting including FWA referrals, RFI/Subpoenas, and regulatory reporting
• OPI Waste and Error referrals
• Hire, train, mentor, delegate work assignments, strategically plan processes for increased efficiency, and coach staff for optimal performance
• Serve as Point of Contact when Director is out of the office
  Develops functional, market level, and/or site strategy, plans, production and/or organizational priorities
• Identifies and resolves technical, operational, and organizational problems outside own team
• Diagnose process improvement opportunities and develop solutions using principles of process excellence and related tools
• Build and demonstrate an understanding of relevant business areas' leadership, structure, responsibilities, and workflow
• Provide standard performance reports (e.g., scorecards, metrics) to update relevant internal and/or external stakeholders on the status of work projects
• Conduct regular meetings with relevant internal and/or external stakeholders to review and discuss updates and outstanding issues
• Develop corrective action plans to address and/or resolve relevant internal and/or external stakeholders' concerns or issues regarding operational issues
• Conduct deep dive program reviews with relevant internal and/or external stakeholders to identify opportunities for continuous improvement
• Ensure relevant internal and/or external stakeholders are provided with correct and/or updated processes, programs, and/or policies
• Partner with relevant internal and/or external stakeholders to develop and/or review potential operational strategies, programs, and plans

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 healthcare compliance or healthcare business experience
• 2+ years of working with one of the OI Value Steams or Operations Risk Management Team
• 2+ years of experience managing a team of 10+ resources
• Working knowledge of state and federal regulatory agencies
• Knowledge of Medicare and Medicaid requirements

Preferred Qualifications:

• Experience communicating complex information via phone conversations and emails to technical and non-technical clients, external customers, internal customers, and executives
• Proven ability to work on less structured, more complex issues with little direction and/or management intervention
• Proven ability to lead project teams consisting of matrix partners and co-workers
• Proven ability to act independently and work on a partnership basis with operations to oversee business risk and controls
• Proven solid business communication skills both oral and written

• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for this role is $104,700 to $190,400 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

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.

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.