Director - Value-Based Care - Compliance

UnitedHealth Group•Eden Prairie, MN

13h•$134,600 - $230,800•Remote

About The Position

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.

Requirements

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

Nice To Haves

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

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