Director of Clinical Compliance - CDI, Risk Adjustment, and EHR Oversight

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 of Clinical Compliance - CDI, Risk Adjustment, & EHR Oversight reports to the Optum Health Chief Compliance Officer (CCO) or designee and will partner closely with other Optum Health compliance leaders and the Optum and enterprise compliance leadership teams. This position is a strategic compliance leadership role serving as a subject matter expert to and key compliance contact for the Optum Health Clinical Excellence function including, but not limited to, compliance oversight and support for strategic clinical initiatives, clinical research, clinical documentation integrity and improvement (CDI) programs, Medicare Advantage risk adjustment activities, technology tools and EHR (e.g., Epic, Athena, eClinicalWorks) workflows that impact provider documentation, and Artificial Intelligence (AI) initiatives impacting clinical care and documentation. This individual will ensure that clinical and business activities align with the organization's compliance program and the seven elements of an effective compliance framework and comply with CMS and OIG standards. This role will require close collaboration with coding compliance, IT, CDI, risk adjustment, coding operations, clinical operations, privacy, and internal audit teams to ensure consistency, alignment, and an integrated approach to risk mitigation.

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:

• Support Optum Health CCO with creation and implementation of comprehensive compliance strategy, risk assessment, and detailed compliance workplan
• Provide influential, collaborative leadership and guidance to business partners on compliance, ethics, and regulatory issues to reduce risk and enable broader business growth objectives
• Support Optum Health CCO and partner with Optum and enterprise compliance teams to deliver an effective compliance program designed to detect, prevent, and correct compliance issues:
  • Lead annual and ongoing compliance risk assessment working with enterprise risk management, enterprise compliance team, and other stakeholders
  • Develop, implement, and update as needed policies, procedures, processes, and best practices with enterprise compliance team to promote compliance with applicable laws and contractual obligations
  • Develop, implement, and update as necessary, training, awareness and educational materials and programs to support compliance and ethics agendas
  • Develop, implement, and update, as necessary, routine monitoring to ensure ongoing compliance with laws, regulations, policies, and procedures
  • Partner with enterprise compliance investigations team to enable them to conduct investigations timely and effectively and support disciplinary guidelines in partnership with the human resources team and business teams
• Specific responsibilities include:
  • Serve as the compliance liaison to IT, CDI, clinical operations, and risk adjustment analytics teams
  • Review and approve new strategic clinical initiatives
  • Review and approve CDI practices to ensure alignment with AHIMA, ACDIS, and OIG guidance
  • Attend and support EHR and related IT governance meetings about deployment of new tools and technologies impacting clinical documentation and risk adjustment
  • Create policies and procedures and review targeted training programs for providers, coders, CDI staff, and operations teams
  • Partner with IT and product teams to review EHR designs, documentation workflows, and provider prompts for compliance risks including review of third-party vendor tools
  • Provide compliance oversight for the design, implementation, and use of AI in clinical documentation, predictive analytics, and decision support tools
  • Design and execute monitoring and auditing activities related to CDI and other initiatives
  • Identify, escalate, and remediate compliance risks, reporting results to compliance leadership and governance committees
  • Support compliance investigations, root cause analyses, and corrective actions

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:

• Bachelor's degree in Healthcare Administration, Nursing, Health Information Management, Business, or related field
• Certifications (at least one):
  • Clinical Documentation Improvement Practitioner (CDIP) or related
  • Certified Risk Adjustment Coder (CRC) or related
  • Certified Professional in Healthcare Information and Management Systems (CPHIMS) or related
  • Registered Health Information Technician (RHIT)
  • Certified in Healthcare Compliance (CHC) or related.
• 8+ years of progressive compliance, risk adjustment coding, CDI leadership experience in healthcare delivery or health plan environments
• Expert knowledge and experience with CMS risk adjustment regulations, OIG guidance, CDI programs and provider query processes, AHIMA standards for CDI, and ICD-10/HCC coding compliance
• Experience working with key healthcare laws and regulations: False Claims Act, Medicare Advantage regulations, and telehealth laws and regulations
• Experience working with and problem solving with senior executives and an initiative-taking leader with a proven history of driving results in a heavily matrixed environment
• Solid background in policy development, governance, and training
• Proven solid verbal and written communication skills and an ability to seek to understand new business proposals, identify risks, and propose risk mitigation solutions

Preferred Qualifications:

• Master's or advanced degree (MD, MBA, MHA, MPH, or JD)
• Health plan or large provider group experience
• Experience working with EHR systems (e.g., Epic, Athena, eClinicalWorks) and their impact on clinical documentation workflows and compliance risks associated with documentation workflows and IT tools

• 
  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 $132,200 to $226,600 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.