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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

The Compliance Consultant acts as a consultant to local Optum Care Delivery Organizations to make medical management processes more effective and efficient. This position has accountability for the development and/or on-going management and administration of clinical value programs. It 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 in the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Resolves highly complex business problems that affect clinical processes and functional requirements
• Participates in the development of measurable clinical business, affordability, and quality goals
• Identifies and prepares recommendations for cross-functional/cross-CDO medical management process improvements and opportunities
• Leverages data from multiple sources and analyzes the data to provide process improvement recommendations
• 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, 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
• 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 clinical experience
• 3+ years of experience in a clinical consulting role
• 3+ years supporting various clinical affordability initiatives in large medical group setting or health plan
• 3+ years of clinical data analysis including identification of improvement opportunities for prior authorization, inpatient utilization management, and clinical claims review
• 3+ years of leadership / management experience
• 3+ years/Intermediate to advanced proficiency in Microsoft applications
• 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
• Experience working on high-profile issues with proven ability to bring to resolution
• Knowledge of NCQA, URAC, state & federal regulatory requirements
• Knowledge of Utilization Management and Complex Case Management processes and performance metrics
• Broad understanding of Medicare, Medicaid regulatory requirements for Medical Management
• Proven capability to work with people at multiple levels within an organization
• Proven excellent verbal & written communication skills
• Ability to travel up to 25%

Preferred Qualifications:

• Proven excellent presentation, and facilitation skills
• Proven solid team player with demonstrated interpersonal and customer service skills

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for this role is $88,000 to $173,200 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and 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.