This leader is responsible for overseeing network pharmacy credentialing, payment operations, and program governance, while serving as a key driver of end-to-end quality and network transformation initiatives. They lead the development and execution of a strategic roadmap focused on optimizing people, processes, and technology to enhance operational efficiency and compliance. The role includes accountability for initial credentialing, ongoing recredentialing, and license verification of pharmacies, as well as the setup and maintenance of pharmacy payment and remittance processes. This leader also governs pharmacy terminations and appeals, ensuring adherence to regulatory and organizational standards, and oversees implementation of transaction fee updates aligned with regulatory requirements. Additionally, they act as product owner for critical platforms, driving continuous improvement and innovation across the network ecosystem.
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:- This role requires cross-organizational partnership and influence to effect change across all OptumRx businesses, operational and technology processes
- Helps define and execute strategies for network operations, ensuring consistency in service delivery outcomes. Translates business strategies into clear objectives for the team
- This role requires cross-organizational partnership and influence to effect change across all OptumRx businesses, operational and technology processes
- Responsible for driving pharmacy relationship management capabilities with their team and collaborating with other teams using latest technologies, processes, and AI tools
- Responsible for end-to-end business process activities - creating, controlling and improving business processes
- Diagnose process improvement opportunities and develop the strategic roadmap for improvements, enhancements, or new tools to solve long term network operational goals
- Enhance the use of AI tools, operational data metrics and analytics to increase operating controls & quality validations
- Apply an operational mindset to identify opportunities to improve quality through automation or improved auditing
- Participate as an active strategic leader of the OptumRx Network Relations (INR) leadership team
- Create a highly engaged workforce, assure performance goals are achieved and support ongoing improvement of customer satisfaction and growth
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 of people management experience
- Experience leading strategic thinking and planning skills, combined with ability to create and execute corresponding operational plans
- Operations and process leadership experience
- Consistent track record for delivering results and driving improvements
- Demonstrated success building, scaling and continuously evolving new functions and organizations
- Proven solid analytical, problem solving and systems thinking abilities
- Proven solid written and verbal communication skills, including executive-level presentations
- Proven ability to operate independently with high ownership and judgment
Preferred Qualifications:- PBM experience
- Business and technology aptitude and experience
- Experience using Agile Methodology
- Experience using AI to improve business results
- Experience leading and motivating a geographically dispersed, employee organization
- Proven highly collaborative leader with a proven ability to influence, align, and build solid stakeholder relationships across technology, business, and external partners
*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 $159,300 - $273,200 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.
