Director, DMHC Affairs - Remote

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Hiring Remotely in Redlands, CA, USA
In-Office or Remote
113K-193K Annually
Artificial Intelligence • Big Data • Healthtech • Information Technology • Machine Learning • Software • Analytics
The Role
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.
The Director, DMHC Affairs Department, will lead high priority strategic initiatives for Optum by providing strong leadership, development and oversight for Knox-Keene licensed Limited and/or Restricted Health Plan activities. Key responsibilities include serving as a liaison to regulatory agencies; directing and leading responses to the DMHC and other state agencies; knowledge of regulatory requirements; and a strong understanding of managed care operations. The position will report to the Optum Vice President, DMHC Affairs Department.
This role requires a unique ability to develop relationships, analyze information and influence multiple stakeholders to increase engagement and achieve desired results. You will be working in a matrixed environment with multiple groups while ensuring that resources are used effectively. Knowledge of Federal and State regulations applicable to Health Plans and IPAs required.
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.
Primary Responsibilities:
  • Maintain knowledge of current and impending regulations and legislation that impact CA Restricted (RKK) and/or Limited Knox-Keene (LKK) licensed entities
  • Develops and executes strategy in accordance with business goals for regulatory engagement and operations
  • Provide regulatory interpretation to internal stakeholders manages work plans to meet company goals, including periodic monitoring and reporting, for adherence to regulatory requirements
  • Serve as a primary RKK/LLK liaison with DMHC and interface with other third parties including health plans, associations, and vendors
  • Direct RKK/LKK routine and ad-hoc DMHC filings, reports and comment letters under the oversight of leadership
  • Collaborate with various departments, and committees; assist in ensuring accurate and consistent understanding of applicable laws, present information and advice in accordance with regulatory requirements and initiatives
  • Serve as the point of contact to support regulatory agency audits and site visits and collaborate with applicable stakeholders (e.g., auditors, regulatory agencies, internal business partners)
  • Ensures that systems, processes and methodologies guarantee effective performance including monitoring, tracking, and quality control, in support of service delivery
  • Operate and collaborate within a matrixed team and highly matrixed business partners across UHG, Optum and delegated entities
  • Drive end-to-end support (not just a leader but a doer) working to meet all deliverables and expectations
  • Supervise, train, and develop the Project Manager(s) within the team

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:
  • 5+ years with health care regulatory matters, current knowledge of managed care operations and industry drivers
  • 3+ years of direct experience leading designing, coordinating, and implementing complex work plans with short timelines and involving multiple contributors
  • Ability to read and interpret regulatory documents from state and federal agencies, such as Department of Managed Health Care (DMHC), Department of Health Care Services (DHCS), Centers for Medicare & Medicaid Services (CMS), and other regulatory agency's rules and regulations, policy and procedure manuals

Preferred Qualifications:
  • Managing health care regulatory matters for a Health Plan
  • Experience with regulatory agency websites and application portals like Department of Managed Health Care Web Portal
  • Direct experience achieving compliance with DMHC, DHCS, CMS, and NCQA expectations
  • Excellent relationship building skills and ability to lead change through influence
  • Able to accommodate and manage ambiguity, to work on abstract issues across functional areas and conceptualize/implement solutions
  • Objective, collaborative approach. Ability to adapt in a dynamic and high-growth environment
  • Demonstrated solid verbal and written presentation skills
  • Superior analytical, organizational, and critical thinking skills

*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 to $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 make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is 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 is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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The Company
HQ: Eden Prairie, MN
160,000 Employees
Year Founded: 2011

What We Do

Optum, part of the UnitedHealth Group family of businesses, 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. At Optum, we support your well-being with an understanding team, extensive benefits and rewarding opportunities. By joining us, you’ll have the resources to drive system transformation while we help you take care of your future. We recognize the power of connection to drive change, improve efficiency and make a difference in health care. Join a team where your skills and ideas can make an impact and where collaboration is key to creating technology that produces healthier outcomes.

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Optum Offices

Hybrid Workspace

Employees engage in a combination of remote and on-site work.

Optum has three workplace models that balance the needs of the business and the responsibilities of each role. These models, core on‑site (5 days/week), hybrid (4 days/week) and telecommute or fully remote, vary by country, role and location.

Typical time on-site: Not Specified
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