Clinical Regulatory Adherence Consultant - Remote

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 to start Caring. Connecting. Growing together.

Positions in this function are responsible for the development and/or on-going management and administration of clinical value programs and other clinical programs within Optum Care. The position provides support and measurement standards for a clinical model that incorporates applicable best practices with proven outcomes. The position will be required to work in a highly matrixed organization and will be focused on implementing value-based solutions in a diverse population of care providers.

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

• Resolves highly complex business problems that affect clinical processes and functional requirements
• As applicable, ensures local care delivery is in compliance with all payor, State, Federal, NCQA, and contractual requirements through implementation/recommendation of appropriate quality controls, checks and balances
• Determines metric and baseline measures for medical management and process change outcomes / controls
• Assists in the development of any required reporting and monitoring assessments in compliance with NCQA standards
• Identifies operational reports, compliance reports, dashboards, and guides others on interventions and suggested improvements
• Promotes regulatory compliance processes and change management on all assigned programs & initiatives
• Participates in the development & maintenance of clinical policies, procedures, SOPs, Job Aids, reporting and assessment tools as applicable to clinical value programs
• Prepares documents and reports for leadership reports, program status reports & compliance updates
• Develops Executive level updates and reports
• Participates in the development of measurable business and affordability goals
• Identifies and prepares recommendations for cross-functional/cross CDO process improvements and opportunities
• Identifies improvements in cross-functional communication process
• Works with new and established CDOs ensuring medical management readiness to successfully enter into risk agreements
• Identifies potential emerging customer needs and promotes innovative solutions to meet them
• Solves unique and complex problems with broad impact on the business
• Participates in the development of business strategy
• Supports complex projects to achieve key business objectives
• Translates highly complex concepts in ways that can be understood by a variety of audiences
• Influences senior leadership to adopt new ideas, products, and/or approaches
• Directs cross-functional and/or cross-segment teams
• Supports all other Medical Management functions and duties 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:

• 3+ years of healthcare leadership / management experience
• 3+ years of experience in clinical consulting role, supporting various clinical affordability initiatives in large medical group setting or Health Plan
• Experience in developing and executing strategies for functions or disciplines that span a large business unit or multiple markets/sites
• Experience with directing others to resolve business problems
• Experience in Population Health Management, Utilization Management, Case Management and/or Clinical Product Management
• Experience with program development and management, including development of strategic initiatives, active implementation, post implementation management and execution
• Experience in Medicare, Medicaid, and Commercial insurance
• Broad understanding of Medicare, Medicaid regulatory requirements for Medical Management
• Knowledge of NCQA, URAC, state & federal regulatory requirements
• Knowledge of Utilization Management and Complex Case Management processes and performance metrics
• Intermediate to advanced proficiency in Microsoft applications
• Proven capability to work with people at multiple levels within an organization
• Ability to travel up to 25%

Preferred Qualifications:

• BSN or RN license
• Undergraduate degree in Nursing, Healthcare Administration, or other Health related field
• Experience working on high-profile issues with proven ability to bring to resolution
• Proven solid team player with demonstrated interpersonal and customer service skills

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington residents is $88,000 to $173,200 annually. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.

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