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Medicaid Compliance Director - Telecommute job at UnitedHealth Group, San Antonio

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The Medicaid Compliance Director is responsible for assisting health plans with general compliance oversight of all activities related to the Medicaid lines of business. The Medicaid Compliance Director is responsible for assisting health plans in the development, implementation and monitoring of the Compliance Program to ensure compliance with all applicable rules and regulations relating to state Medicaid operations. The Medicaid Compliance Director will ensure reporting, auditing and monitoring activities are performed to satisfactory standards of quality and in a timely fashion. With strong organizational skills, the Medicaid Compliance Director assists health plans in achieving goals and objectives; identifies and resolves a variety of regulatory issues; and assists in the development of reporting, in addition to, the implementation and oversight of the auditing and monitoring processes.

The Medicaid Compliance Director assists health plans to ensure that its program fulfills state contractual requirements across all health plan operational areas. The Medicaid Compliance Director also supports strategic evaluations of health plan capabilities in preparation for the response to a state RFPs. The Medicaid Compliance Director also may write/contribute to the health plan response to the state and engage in audit activities to support the development of a winning bid.

•             Develop strategies to promote and encourage a culture of compliance;

•             Coordination of the health plan’s compliance program with their business strategies and practices;

•             Development of required state and other regulatory reporting

•             Support external regulatory audits and corrective action plans, as well as audit readiness activities as appropriate;

•             Support First Tier, Downstream & Related Entities (FDR) program requirements;

•             Advise for the ability to capture and report on potential instances of program noncompliance and potential Fraud, Waste and Abuse (FWA);

•             Ensure health plans have appropriate, up-to-date Compliance policies and procedures;

•             Ensure risk assessments are conducted appropriately to identify compliance risks for all lines of business and ensure appropriate coordination with management activities;

•             Support development and implementation of a risk-based auditing and monitoring program including oversight of subcontractors and delegates;

•             Support the build of various Compliance Committees (Medicaid Compliance Committee, Delegation Oversight Committee, etc);

•             Lead and/or facilitate Medicaid Compliance meetings;

•             Support the production of reports to the Audit Committee of the Board;

•             Assists Health Plan Compliance Departments in working with the business units to ensure compliance with state regulations, laws and policies;

•             Supports ongoing compliance audits to assess effectiveness of policies/procedures and compliance program;

•             Advises on the development, recommendation, implementation, and monitoring the areas of non-compliance with corrective action plans.

•             Assists with state and federal regulatory filings;

•             Serves as liaison between Compliance and business/subject matter expert units related to all compliance audits and business processes;

•             Advises on Medicaid compliance training requirements;

•             Supports the implementation of governance, risk and compliance (GRC) technology;

•             Can support the auditing of other government lines of businesses (Medicare, ACA)

Required Qualifications:

  • Bachelor’s degree
  • 7+ years of health plan medicare industry experience
  • 5+ years of experience in a regulatory/compliance environment required specific to a licensed health plan
  • 5+ years of experience leading and implementing a comprehensive compliance program
  • 2+ years supervisory experience
  • Full COVID-19 vaccination is an essential requirement of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance

Preferred Qualifications:

  • Post-graduate degree
  • Certified healthcare compliance CHC
  • CMS and State regulatory reporting experience
  • Exceptional written and verbal communication skills
  • Superior analytical, organizational and problem solving skills


To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.


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Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $113,500 to $218,100. The salary range for Connecticut / Nevada residents is $113,500 to $218,100. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.

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


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.


Job country: United States

City: San Antonio

Category: Compliance Managers

Location: San Antonio, TX, United States

Job posted 2022-06-04

This job is expired

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