Regulatory Analyst - National Remote

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 Regulatory Analyst is a critical role designed to support West region delegation compliance. This position is essential for ensuring that our organization remains compliant with new regulatory and payor-specific requirements and rules. The analyst will play a pivotal role in supporting the tracking and implementation of these requirements. They will also perform internal audits, corrective action, ongoing support, and relationship management for non-owned IPA groups as well as any other sub-delegation or required vendor audits for all West Region markets ensuring that our processes align with contractual, legal, and regulatory requirements. In addition, they will oversee NCQA accreditations and regional UM committee meetings which are required for delegation compliance.

You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

Regulatory Tracking and Implementation:

• Monitor and track new regulatory or payor-specific requirements and rules
• Support implementation of necessary changes to ensure compliance across the West region

Internal Audits and Corrective Actions (4 non-owned IPAs and MSO):

• Assist in conducting thorough sub-delegation/vendor audits to identify compliance gaps
• Support development and implementation of corrective action plans to address any identified issues

Ongoing Support and Relationship Management:

• Provide ongoing support to ensure continuous compliance
• Support management of relationships with non-owned IPA groups
• Assist with sub-delegation and required vendor audits and remediation for all markets

Utilization Management Committees:

• Support Utilization Management Committees across the region by providing necessary data, analysis, and compliance updates

NCQA Accreditations:

• Support the success of new NCQA accreditations and oversee maintenance of existing accreditations
• Coordinate with relevant teams to compile evidence, update policies, and meet accreditation standards

Support regulatory program audits (DMHC, CMS, DHCS, NCQA)

• Support proactive mock audits to ensure audit readiness
• Identify potential risks and gaps related to regulatory audits; assist in proactive remediation

The information listed above is not comprehensive of all duties/responsibilities performed. This job description is not an employment agreement or contract. Management has the exclusive right to alter this job description at any time without notice.

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:

• High School Diploma/GED (or higher)
• 5+ years of experience in managed care
• 1+ years of experience in standardizing processes, conducting audits, and implementing corrective actions to mitigate compliance risks
• 1+ years of experience in stakeholder collaboration, fostering effective partnerships, and maintaining adherence to performance metrics and service level agreements
• 1+ years of experience in analytics, reporting, and documentation skills to support compliance monitoring and regulatory inquiries
• Ability to work a full-time schedule & work mountain/pacific hour, as needed

Preferred Qualifications:

• 10+ years of experience in managed care
• Expertise in healthcare regulations, NCQA standards, and delegation agreements across multiple lines of business
• Exposure to federal and state regulations such as Centers for Medicare and Medicaid Services (CMS), the California Department of Managed Health Care, and California Department of Health Care Services
• Proven experience in assisting in the development and execution of business strategies

Soft Skills:

• Promote a positive and productive work environment by acting maturely and responsibly, satisfactorily performing job responsibilities, and conducting oneself in a professional, courteous, and respectful manner toward fellow employees, physicians, and patients
• Must hold relationships to a high standard - respectful approach to all people and interactions, listening to understand, taking emotional accountability, and exemplifying balance of self with all interactions, being receptive to feedback and opportunities, keeping an open mind towards growth
• Integrate Lean principles, practices, and tools to improve operational efficiency, reduce costs, and increase customer satisfaction
• Follow written and oral instructions and complete routine tasks independently
• Complete annual compliance training on HIPAA/Privacy/Confidentiality/Non-Discrimination/Harassment/Integrity Statement and signed Agreements
• Ensure confidentiality of patient information following HIPAA guidelines and company policies
• Attend training to meet requirements of the job position and as needed or mandated by company policies and regulations
• Have regular and predictable attendance

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

The salary range for this role is $59,500 to $116,600 annually based on full-time employment. 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.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

#RPO, #GREEN