Job: Compliance Officer - Ridgeland, MS

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Jobing Description

What makes your Compliance career greater with UnitedHealth Group? Growth opportunities with the potential to impact the health care system ensure it will always be challenging and exciting.


The Compliance Officer monitors changes to laws and regulations to ensure compliance with State & Federal laws, regulations and mandates. This position will establish and implement standard policies, procedures, processes and best practices across United Healthcare Community and State to promote compliance with applicable laws and contractual obligations. The Compliance Officer will collaborate with health plan attorney to conduct state-specific legal research and monitor changes to requirements to mitigate risks and achieve compliance. The Compliance Officer will support the collection of data for regulatory filings, coordinate and develop reports, projects, assessment tools to verify compliance. This position may develop compliance communications and drive problem resolution for a business.

-Develop and manage site Compliance Committee meetings.
-Develop and maintain an effective Compliance Program, including compliance-related policies.
-Monitor changes to requirements to mitigate risks and achieve compliance.
-Support the collection of data for regulatory filings.
-Predicts emerging customer needs and develops innovative solutions to meet them.
-Solves unique and complex problems with broad impact on the business.
-Proven oral presentation skills.

-Ensure procedures are established to support timely communication and education regarding the Compliance Program.
-Coordinate and support implementation of Compliance training and educational programs with the appropriate business areas.
-Ensure that procedures are in place to review and report possible violations in accordance with the reporting requirements as outlined in the Code of Conduct.
-Coordinate with Legal Counsel, Government Programs Compliance Investigations, and others as needed to conduct investigations, coordinate development and implementation of appropriate corrective action.
-Collaborate with business staff to develop and implement monitoring and auditing procedures as appropriate to determine the level of compliance with key regulatory requirements.
-Coordinate all external Regulatory Audit activity and any resulting corrective actions with the Government Programs Audit Management Team.
-Work with operational leaders to ensure understanding and communication of Plan-level regulatory contract requirements.
-Ensure that standards and processes are in place to ensure that engagement of vendors by the Plan meets regulatory and business requirements for effective pre-contracting evaluation and service level requirements; ongoing monitoring; and contract termination activities.
-Ensure that the Plan has established processes and procedures to meet regulatory and contract requirements relating to receipt; investigation; resolution; and reporting of fraud and abuse against the Plan or its members.
-Coordinate privacy related activities with the Government Programs Privacy Team to ensure training and education is provided to Plan employees and others as required.
-Primary and key point of contact for regulatory agencies interfacing with the health plan. Serve as the lead account manager for all state agency contracts.
-Communicates and oversees partnership with and implementation of state initiatives and changes. Support the health plan's response to program changes, including business development initiatives.

Skills / Requirements

-Minimum of 3 years experience in direct management of a compliance program or 5 years of legal regulatory experience in lieu of direct management of compliance program
-Bachelor's degree or equivalent experience
-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 plan
-Excellent verbal and written communication skills
-Demonstrated ability to work effectively and congenially with employees at all levels (matrix environment)
-Detailed understanding of government requirements and expectations for health care compliance programs
-Commitment to teamwork
-Consensus builder who strives to develop partnerships, teamwork and good working relationships

-Prior supervisory experience is a plus



UnitedHealthcare Community & State is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.

If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care at UnitedHealthcare Community & State.

We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.

This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.

You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
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.