589955 - Medicaid Healthplan Compliance Officer (Director) - Pennsylvania

Bring us your experience, your head for strategy, your strength with relationships and your eye for opportunity. In return we offer an unmatched place to grow and develop your career among a richly diverse group of businesses driven by the power and stability of a leading health care organization. Come help us heal and strengthen the health care system as you do your life's best work.(sm)

UnitedHealthcare Community & State, part of the UnitedHealth Group family of companies, is looking for an experienced Medicaid Healthplan Compliance Officer to join our dynamic Compliance team.  Things are exciting at UHG as we are experiencing unprecedented growth, and looking for someone with the right stuff for our team at our Philadelphia, PA location. The Compliance Officer is an individual contributor role responsible for supporting all aspects of the compliance program for our Pennsylvania Medicaid Healthplan. This position reports directly to the Region Compliance Director, and indirectly to Plan Leadership, and serves as a first point of contact for state regulators on compliance matters related to the plan.  Provides leadership to and is accountable for the performance and results through multiple layers of management and senior level professional staff.

The Compliance Officer will monitor changes to laws and regulations to ensure compliance with State & Federal laws, regulations and mandates. This individual will develop, implement and maintain the compliance program within UnitedHealthcare Community & State Operations in order to ensure that we are meeting company guidelines and CMS requirements. They will establish and implement standard policies, procedures, processes and best practices across UnitedHealth Group to promote compliance with applicable laws and contractual obligations. The Compliance Officer will conduct state-specific legal research and monitor changes to requirements to mitigate risks and achieve compliance. Will also support the collection of data for regulatory filings, coordinate and develop reports, projects, and assessment tools to verify compliance. They will develop compliance communications and drive problem resolution for a business.

Ideal candidates will have experience in a Pennsylvania Medicaid regulatory or compliance role, will have experience working with state level regulators, will have experience working with OIGs, and will have strong project management experience and experience working in a matrixed environment.  Ideally, candidate will work from our Philadelphia office, though there may be flexibility for a stellar candidate to work from one of our other UHG locations in Pennsylvania.

Primary Responsibilities:

• Develop and manage site Compliance Committee meetings


• Ensure written standards and procedures


• Provide training, communications and education


• Ensure proper reporting and response to state stakeholders


• Conduct auditing and monitoring, to ensure compliance


• Oversee contract compliance activities and vendor oversight


• Remain vigilant regarding fraud, waste and abuse


• Ensure privacy within the healthplan

Required Qualifications:

• Bachelor's degree


• 5+ years of experience in a role responsible for regulatory compliance, preferably in a leadership role


• Experience in a strategic role, ideally leading and implementing a comprehensive compliance program


• Experience developing and presenting training programs


• Solid experience in managed care and government programs


• Experience leading audits and major program initiatives


• Experience developing relationships with regulatory agencies


• Ability to identify root cause issues and ensure appropriate corrective action


• Experience and understanding of HIPAA and state privacy laws


• Experience managing multiple projects/tasks; proven history of successful results in managing issues and driving strategic program initiatives


• Experience working as a Subject Matter Expert in a large, highly-matrixed organization, working with various business segment and/or stakeholders


• Proven ability to think strategically and to translate strategic directives into tactical initiatives


• Proven ability to drive cross-functional teams to deliver operational compliance


• Adept at understanding complex concepts and situations presented by the business environment


• Ability to assess complex problems and provide the appropriate compliance solutions


• Objective, collaborative approach. Ability to adapt in a dynamic and high-growth environment


• Demonstrated ability to communicate in effectively in written & verbal English


• Superior analytical, organizational and problem solving skills


• Intermediate or better proficiency using MS Excel and MS Word

Preferred Qualifications:

• Master's degree or JD


• 3+ years of experience and knowledge working with Pennsylvania Medicaid


• 3+ years of experience and knowledge working with state level regulators


• Certification in Healthcare Compliance (CHC), or similar

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 14 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, 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.

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