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Optum

Regulatory Adherence Director - Remote

Posted 15 Minutes Ago
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In-Office or Remote
Hiring Remotely in Cypress, CA, USA
113K-193K Annually
Senior level
In-Office or Remote
Hiring Remotely in Cypress, CA, USA
113K-193K Annually
Senior level
Leads implementation of state legislation, Medicaid directives, CMS guidance, contracts, and health plan mandates affecting behavioral health operations. Oversees regulatory governance, compliance monitoring, risk management, remediation, evidence of compliance, and executive reporting. Coordinates cross-functional stakeholders across Legal, Compliance, Clinical Operations, Claims, Technology, and health plans, serving as a behavioral health regulatory subject matter expert and advising leadership on implementation strategies and compliance risks.
The summary above was generated by AI
Requisition Number: 2394788
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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
Position Summary: Responsible for implementation of new state legislation, customer specific contract amendments and/or state directives. Lead governance of regulatory implementations, compliance oversight, risk management, and regulatory readiness while operational teams retain accountability for day-to-day processes and issue resolution.
You'll enjoy the flexibility to work remotely* from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.
Main Duties and Responsibilities:
  • Interpret and assess federal and state regulatory requirements, contract amendments, Medicaid directives, CMS guidance, and health plan mandates impacting behavioral health operations
  • Translate regulatory requirements into actionable business, operational, clinical, and system implementation requirements in conjunction with compliance and legal as required
  • Lead governance and oversight of regulatory implementation initiatives across multiple business functions, products, and lines of business
  • Coordinate cross-functional stakeholders to support timely and compliant implementation of regulatory, contractual, and policy requirements
  • Facilitate regulatory implementation project workgroups, governance forums, and executive stakeholder discussions
  • Identify, assess, and escalate regulatory and compliance risks that may affect operations, health plan obligations, provider networks, reimbursement, member access, or audit readiness
  • Lead oversight of compliance remediation efforts, including corrective action planning, gap analysis, interim controls, and validation of sustainable solutions
  • Establish and maintain regulatory intake processes to determine appropriate ownership, prioritization, and governance requirements for new requests and initiatives
  • Evaluate incoming requests to determine whether they require regulatory adherence leadership, compliance oversight, operational ownership, or monitoring
  • Ensure regulatory initiatives have clearly defined scope, accountable business owners, implementation milestones, success measures, reporting cadence, and closure criteria
  • Monitor implementation progress and confirm regulatory requirements have been operationalized and supported by documented evidence of compliance
  • Develop and maintain compliance monitoring strategies, implementation project tracking, executive reporting, and risk-tracking mechanisms
  • Partner with Legal, Compliance, Regulatory Affairs, Health Plans, Clinical Operations, Network Management, Claims, Technology, and operational teams to support enterprise alignment and regulatory readiness
  • Serve as a behavioral health regulatory subject matter expert and trusted advisor to leadership on emerging requirements, implementation strategies, and compliance risks
  • Serves as the SME and provides customer-facing support for regulatory projects
  • Provide executive-level communications, recommendations, risk assessments, and strategic guidance related to regulatory implementation projects and compliance initiatives
  • Document all projects, updates, and associated reference materials into Workfront for tracking and proof of compliance

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:
The successful candidate should demonstrate the following education, experience, and professional capabilities:
  • Bachelor's degree in healthcare administration, public policy, business, behavioral health, compliance, or related field;
  • Demonstrated knowledge of federal and state healthcare requirements, CMS guidance, Medicaid directives, health plan contracts, and regulatory implementation practices
  • Experience leading large, complex, cross-functional initiatives involving Legal, Compliance, Regulatory Affairs, Clinical Operations, Network Management, Claims, Technology, and health plan partners
  • Solid governance, risk management, issue-escalation, and compliance-remediation capabilities, including the ability to establish interim controls and sustainable closure criteria
  • Experience developing regulatory implementation project monitoring, governance reporting, and evidence-of-compliance processes
  • Proficiency with MS Word, Excel, PowerPoint, Copilot, and Outlook

Preferred Qualifications:
  • Advanced degree
  • 5+ years experience in healthcare regulatory implementation, compliance, operations, or health plan administration, with behavioral health and Medicaid experience
  • Experience supporting multi-state regulatory implementations, behavioral health programs, Medicaid products, audit readiness, and enterprise-level change initiatives
  • Proven ability to interpret complex regulatory and contractual requirements and translate them into clear business, operational, clinical, and system requirements
  • Ability to influence outcomes and establish accountability across teams without direct reporting authority
  • Solid executive communication skills, including the ability to prepare concise summaries, risk assessments, recommendations, dashboards, and leadership presentations
  • Excellent analytical, organizational, facilitation, and problem-solving skills, with the ability to manage multiple priorities and competing implementation timelines
  • Demonstrated judgment in distinguishing regulatory implementation and compliance-oversight needs from routine operational ownership and issue resolution
  • High attention to detail, sound professional judgment, and commitment to regulatory readiness, operational accountability, and continuous improvement

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $112,700 - $193,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.
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 help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.
UnitedHealth Group and its affiliated brands are 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 and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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