Regulatory Adherence Senior Consultant- Benefit Operations, Medicare- Minneapolis, MN (preferred) or Telecommuter - Full-time / Part-time

No industry is moving faster than health care. And no organization is better positioned to lead health care forward. We need attention to every detail with an eye for the points no one has considered. The rewards for performance are significant. You'll help improve the health of millions. And you'll do your life's best work.

Are you a subject matter expert in project management, scope definition, risk identification, methodology and resource allocation or facilitation? Assist us with strategic initiatives crossing business teams and operating groups as a Consultant to coordinate and complete projects, define performance and results and manage outcomes. You'll investigate non-standard requests and problems, make presentations to senior leadership, ensure project documentation is accurate, and ensure projects are completed on time and within scope. You will review pertinent data and facts to identify and solve issues, mitigate risks, prioritize your work load, and lead or contribute to ad hoc projects.

Purpose of Job:

Serves as the single point of intake and contact for our upstream regulatory partners and brings forward to Benefit Operations activities that require impact assessment, solution analysis, implementation and/or support. This position reviews the work of others, develops innovative approaches and is sought out as expert. Also serves as a leader/ mentor in implementing solutions. Coordinates related activities across functional areas. Communicates project progress thru stage gate reviews and documents regulatory adherence action plans in accordance with business process engagement model.

This position will focus (initially) on the Medicare segment of UnitedHealthcare's membership.

Positions in this function are responsible for the following:

• Assesses and interprets customer needs and requirements

• Identifies solutions to nonstandard requests and problems

• Solves moderately complex problems and/or conducts moderately complex analyses

• Works with minimal guidance; seeks guidance on only the most complex tasks

• Translates concepts into practice

• Provides explanations and information to others on difficult issues

• Coaches, provides feedback, and guides others

• Acts as a resource for others with less experience

• Anticipates customer needs and proactively develops solutions to meet them

• Certification in project management strongly preferred

Job Components (List the major job responsibilities, accountabilities and key responsibilities in order of priority.  Also include any relevant scope measures as they pertain to the duties listed below):

Major Responsibilities
Accountable
• Works with upstream resources to ensure that all relevant information is provided

• Communicates with leadership on the status of implementation, risks and concerns

• Ensures large/complex implementations are coordinated at the READY program level

• Drives “program metrics” like inventory, aging, status of “5 Ons” for regulatory items in the Benefit Operations queue

Responsible
Intake

• Performs initial intake of all regulatory items and complete documentation

 
• Engages appropriate stakeholders (within Benefit Operations and delegated entities) to perform broad impact assessment/ prioritization

• Identifies regulatory requirements that will require cross solutioning or impact multiple areas for READY program management oversight

Impact Assessment

• Determines initial impact assessment:  which functional areas within Benefit Operations will be likely to be impacted.

• Partners with functional area leaders and SMEs to determine full impact scope and solutions

• Validates and verifies focused impact assessments from functional area will meet regulatory requirements (depending on type of trigger)

• Coordinates cross-functional time-lines and solutioning 

Implementation
• Holds overall Benefit Operations implementation responsibility utilizing required project plan & templates; engaging all partners as needed in each phase

• Works with stakeholders (external to Benefit Operations, including IT, Clinical Services, Finance, Rx) to validate that implementation plans will achieve desired results (prior to implementation)

• Engages SMEs/Business Analysts as required, sets clear expectations and requirements, and provides ongoing support to ensure quality and implementation timeliness

• Engages functional leads and Strategic Planning if resource considerations to support process change are needed

• Performs final validation and signs attestation (on cross functional items) that implementation is complete and communicates status  to leadership

Monitoring (Consultative role)

• Confirms level of monitoring needed and coordinates with Business Process Quality Management (BPQM), Compliance, and Functional Areas (depending on type of trigger and impact across Ben Ops)

• Assists BPQM /Compliance in prioritization and impact assessment of prioritization items

• Serves as point of contact for resolving post deployment issues or remediation activities to correct existing process gaps.

Program-level Responsibility
• Manages implementation and regulatory adherence new Medicare mandates; manages READY's inventory of intake-items to ensure effective and efficient flow through the pipeline for assigned Benefit Operations Functional Areas.

• Coordinates with Community & State partners.  Produces weekly updates.

• Leads Core Team meetings with Quarterbacks and related SMEs to foster communication, obtains / provides project status at each required stage gate; obtains required sign offs/consensus to move forward

• Provides strategic and creative input into shaping the READY team READY-for-Medicare operations:  proposes ideas for focus, continuous process improvement, innovation, prioritization

• Creates high level Process Flows with related teams as needed, depending on complexity

• Supports initiatives related Benefit Operations READY activity i.e. requirements development, capital funding presentations, etc.

• Consults on / assists with feedback process for draft regulations if/as requested by Regulatory Affairs, C&S Operations Compliance, and/or M&R Operations Compliance 

• Solid knowledge of Benefit Operations  Organization and high level end to end processes Knowledge of Medicare regulations that govern Benefit Operations highly desirable

• 4 + years of Project Management experience required 

• Experience working directly with senior level business stakeholders; ability to navigate and work within a highly matrixed organization and influence and negotiate with individuals outside of immediate management umbrella; Ability to build and maintain relationships within and outside of the immediate team.

• Ability to work with teams or individually with minimal direction: be self-directed

• Leadership skills: facilitation, consensus-building, decision-making. Ability to lead a brainstorming session to select best solution.

• Natural curiosity, creativity, critical thinking and problem-solving ability:  to get to root causes, to ask “the 7 WHY”s

• Ability to influence without formal authority

• Excellent work ethic; great organization skills; ability to consistently meet deadlines

• Strong operational, process re-engineering skills, with attention to detail

• Excellent work ethic; great organization skills; ability to consistently meet deadlines

• Ability to communicate with multiple levels of management including Directors, Executive Directors, VPs:  Excellent verbal, written and presentation skills required

• Intermediate proficiency with MS Office (Powerpoint, Word, Excel, Outlook, Visio) required

• Excellent verbal, written communication and presentation skills

• Ability to build trust and form effective relationships with stakeholders

Desired Qualifications:

• Undergraduate degree or equivalent experience preferred

• Regulatory & Compliance background strongly preferred

• Project Management certification strongly preferred

• Familiarity with systems such as COSMOS, NICE, GPS, STARS, ETS a big plus

• Location in Minneapolis, MN is highly desirable 

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 17 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.SM

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.


UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.