581070 - Corporate Integrity Program Manager - Sacramento, CA

Optum360, part of the UnitedHealth Group family of companies, is a dynamic new partnership formed by Dignity Health and Optum to combine our unique expertise. As part of the growing family of UnitedHealth Group, we'll leverage all our resources to bring financial clarity and a full suite of revenue management services to health care providers nationwide. We are currently looking for an experienced Corporate Integrity Program Manager to join our dynamic Compliance team in Rancho Cordova (Sacramento) CA.  The people who work at Optum are among the brightest and most inventive in the industry. Work alongside us today and discover a culture of integrity, compassion, relationships, innovation and performance. Our team enjoys conversation-changing, life-changing, world-changing opportunities throughout their careers. Join us and see what it's like to do your life's best work.(sm)

The Corporate Integrity Program Manager is responsible for working with Client management to coordinate the implementation of and the ongoing monitoring and maintenance of Optum360 responsibilities under the client Corporate Integrity Agreement (CIA). The Corporate Integrity Program Manager will have direct accountability throughout Optum360 for tasks required by the CIA. The Corporate Integrity Program Manager will work to ensure that the CIA's core obligations are implemented within the required timeframes set out by the CIA to protect client and Optum360 assets from financial loss and to prevent non-compliance with the terms of the CIA.

The Corporate Integrity Program Manager shall comply with applicable laws and rules, including the UHG/Optum360 policies and procedures that apply to his/her job responsibilities, seeks guidance when in doubt, promptly report any potential or suspected violation of the UHG/Optum360 policies or applicable laws/regulations and when requested, assists Optum360 and/or client personnel in investigating all allegations of violations. The Program Manager shall assist in risk evaluation and work collaboratively with Optum360 leaders to implement, monitor and mitigate risk, and develop corrective plans as required by the CIA workplan.

Primary Responsibilities:

• Works with Optum360 and client leadership to analyze the CIA to determine and communicate obligations under the terms of the agreement


• Develops strategies, plans and programs, to ensure CIA requirements are effectively implemented


• Serves as a resource to affected Optum360 operations team for CIA related issues


• Communicates CIA requirements and reports on progress of implementation and monitoring activities to business units and service area leadership


• Communicates CIA penalties for non-compliance to operations teams and Optum360 leadership


• Utilizes expertise, experience and leadership skills to assist operations teams in overcoming operational impediments to effectively implementing the CIA


• Assesses organization competencies which may impact successful CIA implementation


• Provides education regarding CIA core obligations to operations teams, Optum360 leadership and others as needed


• Monitors Optum360's progress in meeting CIA related compliance workplan objectives including scheduling, planning, tracking and correcting implementation performance


• Monitors audit results, investigations, reports, compliance policy implementation, and educational requirements and physician transactions for adherence to CIA core obligations


• Develops reporting tools to monitor and report compliance with all obligations of the CIA; manages all project documentation


• Oversees and coordinates the collection and submission of data required to be submitted to the client for inclusion in the CIA Annual Report(s)


• Works with Independent Review Organization (IRO) as it performs the coding and billing audits required by the CIA


• Facilitates the work of the IRO in assessing and evaluating adherence to the compliance obligations in the CIA that relate to Optum360 activities


• Monitors the investigation of hotline complaints for potential reporting under CIA


• In conjunction with Optum360 and client Legal counsel, Chief Compliance Officer and Senior management, review issues that may be reportable/disclosable under the CIA


• Works with Chief Compliance Officer and Sr. Director of Compliance and Privacy to articulate to the operations teams the CIA's core obligations and accountabilities


• Ensures the operations teams are aware of the progress of the CIA implementation in business units. Updates Optum360 leadership regularly on the progress of the CIA implementation and maintenance


• Prepares CIA status reports for Optum360 leaders and client Audit and Compliance Committee


• Reports to the Sr. Director of Compliance and Privacy and interacts with all levels of management at Optum360, including but not limited to CEO, COO, CFO, CMO, General Counsel/Chief Compliance Officer and key members of the medical staff, directors and managers


• Interacts with multiple functions within the client organization including Compliance, Legal, Reimbursement, Finance, Operations, Human Resources and Internal Audit as necessary to facilitate implementation and maintenance of the CIA

Required Qualifications:

• Bachelor's degree in a health care and/or business related field


• 5+ years of working experience in administrative, financial or clinical position in a hospital or health system with a minimum of 3+ years of management experience


• 3+ years of experience working in one or more areas of healthcare compliance


• Demonstrates experience in identifying and effectively resolving operational issues


• Knowledgeable in Medicare and MediCal requirements for acute and ambulatory care


• Demonstrates ability to communicate effectively with all levels of an organization


• Ability to communicate clearly both verbally and in writing, including ability to present ideas and concepts effectively across organizational levels


• Ability to manage competing multiple priorities and projects simultaneously with inflexible timelines


• Ability to function effectively in a dynamic and challenging environment and to affect change if necessary


• Demonstrates ability to analyze problems and issues from a variety of perspectives and to understand legal, compliance, risk and financial impact of decisions


• Self-starter with proven ability to deliver operational compliance


• Objective, collaborative approach; ability to adapt in a dynamic and high-growth environment


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


• Intermediate or better proficiency with MS Excel, MS Word & MS PowerPoint


• Ability to travel to provider locations; up to 15% of the time

Preferred Qualifications:

• Post-graduate or law degree


• Preference for professional certification in one or more of the following areas: Healthcare Compliance Professional (HCP), Certified Internal Auditor (CIA), Project Management Professional (PMP), Certified Healthcare Financial Professional (CHFP), or similar

Health care isn't just changing. It's growing more complex every day. ICD10 replaces ICD9. Affordable Care adds new challenges and financial constraints. Where does it all lead? Hospitals and health care organizations continue to adapt, and we are a vital part of their evolution. And that's what fueled these exciting new opportunities. Optum360 is a dynamic new partnership formed by Dignity Health and Optum to combine our unique expertise. As part of the growing family of UnitedHealth Group, we'll leverage all our resources to bring financial clarity and a full suite of revenue management services to health care providers nationwide. If you're looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to 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.

Job Keywords: health, healthcare, medical, insurance, audit, auditor, revenue, compliance, HFMA, CIA, CHFP, Rancho Cordova, Sacramento, CA
California