Health Plan Compliance Officer

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Health Plan Compliance Officer
Responsibilities: 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.

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