Bring us your experience, your head for strategy, your strength in building strong working teams and relationships and your eye for opportunity. In return we offer an unmatched place to grow and develop your career. Come help us heal and strengthen the health care system as you do your life's best work.

The Sr. Director Business Operations, Appeals & Grievance ensures compliance with all relevant State & Federal laws, regulations and mandates relating to the work of Specialty Networks.  This individual will operationalize standard policies, procedures, processes and best practices across Specialty Networks and promote compliance with applicable laws and contractual obligations. The Director will participate in state-specific legal research and monitor changes to requirements to mitigate risks and achieve compliance. Will also support the collection of data for regulatory filings, coordinate and develop reports, projects, assessment tools to verify compliance. They will develop compliance communications and drive problem resolution for a business. Specifics include:

- Operationalizes changes to applicable  laws and regulations to ensure compliance with State & Federal laws, regulations and mandates.
- Interprets policies, procedures, processes for the Appeals & Grievances department to promote compliance with applicable laws and contractual obligations.
- Responds to regulatory inquiries, including identifying, reviewing and interpreting data
- Assists in the development of best practices across Specialty Networks to promote compliance with applicable laws and contractual obligations 
- Participates in conducting state-specific legal research and monitors changes to requirements to mitigate risks and achieve compliance
- Supports the collection of data for regulatory and customer audits, identify and support the production of documentation
- Supports the collection of data for regulatory filings, coordinate and develop reports, projects, assessment tools to verify compliance.
- May develop compliance communications and drives problem resolution for Specialty Networks.
- Supports the development and implementation of Corrective Action Plans; monitors implementations and ensures proper communication to appropriate stakeholders
- Oversees records management function for the Appeals & Grievance department
- Works collaboratively with UHG Regulatory & Compliance, Government Affairs, and other internal departments  
- Provides overall management of the Business Operations Assurance team and direct supervision of professional level staff

- Bachelor's degree required
- Experience in managed care, Medicare and/or Medicaid required
- 5+ years of regulatory and compliance work including interpreting policies, procedures, processes for A&G and responding to regulatory inquiries required
- 5+ years of experience directly managing/supervising professional level staff
- Proficient in MS Excel, PowerPoint and Word required
- Excellent verbal and written, presentation/communication skills
- Proven ability to identify needs, own and/or implement projects and workgroups
- Experience with complex analyses, conceptual work, critical thinking
- Ability to plan and delegate work and implementation activities
- Demonstrated success working collaboratively and effectively with internal customers and stakeholders required
- Ability to mentor/grow staff and lead cohesive team building efforts
- Behavioral health experience preferred

- Advanced degree preferred

OptumHealth is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.

OptumHealth helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their health care needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.

At OptumHealth, you will perform within an innovative culture that's focused on transformational change in the health care system. You will leverage your skills across a diverse and multi-faceted business. And you will make contributions that will have an impact that's greater than you've ever imagined.

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.