The Health Plan Compliance Officer is a leadership role supporting all aspects of the compliance program for the health plan. As a member of the health plan Senior Leadership Team, the Health Plan Compliance Officer will provide strategic leadership partnering with various health plan leaders and matrix partners as needed to execute on issues of non-compliance or areas of identified risk(s). The Health Plan Compliance Officer is accountable to the Health Plan Chief Executive Officer and the Board of Directors.

This role requires development of relationships with executive level business leaders and understanding of health plan and functional business structures. The Health Plan Compliance Officer actively collaborates with business leaders to implement the UHC Compliance Program at the health plan level, ensuring operational accountability for compliance with the obligations that govern our business through: (1) business owner accountability; (2) governance process and structure; (3) standardized processes, tools and accountabilities; and (4) clear outcome measures.

• Serve as key point of contact for regulatory agencies interfacing with the health plan regarding Compliance issues, Regulatory Audits and Corrective Actions
• Develop and manage site Compliance Oversight Committee meetings and reporting to senior leadership and the Board of Directors
• Develop and maintain an effective Compliance Program, including compliance-related policies and procedures
• Ensure timely communication and education regarding the Compliance Program
• Coordinate and support implementation of Compliance training and educational programs with the appropriate business areas
• Oversee health plan-level Compliance and Ethics reporting
• Coordinate with Legal Counsel, UHC Compliance Investigations, and others as needed to conduct investigations, coordinate development and implementation of appropriate corrective action
• Oversee all regulatory audits of the health plan, including any associated remediation and instances of non-compliance (in partnership with UHC Audit Management and Corrections teams)
• Oversee health plan risk assessment process, including identification, mitigation and management of top risks
• Provide input into Key Compliance Indicator (KCI) development based on health plan risk assessment (e.g. identify health plan business SMEs, serve as health plan SME for regulatory requirements)
• Demonstrate compliance risks are proactively identified and addressed through prevention, detection, correction and monitoring strategies
• Engage with UHC Corrections to ensure effective corrective action request process
• Work with operational leaders to ensure understanding and communication of Plan-level regulatory contract requirements
• Ensure that standards and processes are in place for vendors contracted by the Plan that meet regulatory and business requirements
• Oversee the health plan Fraud, Waste and Abuse program and 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 (in partnership with UHC Program Integrity)
• Coordinate privacy related activities with the UHC Privacy Office to ensure issue resolution occurs as appropriate and training and education is provided to Plan employees and others as required
• Communicate regulatory changes and partner with Health Plan and matrix teams for implementation
• Supports the health plan's response to program changes and opportunities, including business development initiatives
• Perform other 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.

• Bachelor's degree or equivalent work experience
• 3+ years of experience in a role directly managing key aspects of a compliance program
• 3+ years of experience and understanding of HIPAA and state privacy laws
• Experience leading audits and major program initiatives
• Experience working with regulatory agencies

• Advanced Degree (Master's or JD)
• 2+ years of experience with managed care and/or government programs
• Experience and knowledge working with Medicaid compliance
• Professional certification (Certified in Healthcare Compliance - CHC or similar)
• Experience in a strategic role, ideally leading and implementing a comprehensive compliance program
• Experience with fraud, waste and abuse activities and reporting, including interaction with regulatory agencies

Job Keywords: Compliance, regulatory, compliance programs, state privacy laws, government programs, Medicaid, project management, Manhattan, Albany, Brooklyn, Long Island, New York, NY