at UnitedHealth Group in Schaumburg, Illinois, United States
Job Description
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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
+ Lead and assist with contractual negotiations, special projects and RFPs
+ Develop and execute on provider strategy development
+ Lead projects, define performance and goal execution, and drive results
+ Investigate non-standard requests and issues, complete projects on time and within scope
+ Monitor and document project milestones and outcomes throughout the project lifecycle to ensure deployment dates and project implementation are successful and make clear presentations to leadership
+ Maintain an ongoing knowledge of provider’s business as well as their contract with OptumRx
+ Provide positive alternatives to complex situations encountered by providers and manage expectations
+ Escalate provider concerns internally and to help solve complex issues
+ Communicate effectively with providers via face-to-face meetings, conference calls and written correspondence
+ Manage contractual obligations including but not limited to contract compliance
+ Be a self-starter, produce quality work, make decisions, and deliver on commitments
+ Drives development of the provider network yielding a geographically competitive, broad access, stable network that achieves objectives for cost performance
+ Performs contract negotiation and pricing – evaluates and negotiates contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls
+ Establishes and maintains solid business relationships with Pharmacy providers, and ensures the network composition includes an appropriate distribution of provider specialties
+ Balance financial and operational impact of contracts to providers, members, and different customer groups when developing and/or negotiating contract terms
+ Support evaluation of market rates and provider performance in order to establish provider rates and negotiation strategies
+ Explain the organization’s direction and strategy to internal partners and providers in order to justify methodologies, processes, policies, and procedures
+ Identify and gather information regarding provider issues in order to develop and/or implement strategy to resolve matter, keep manager informed of progress, or escalate issue to appropriate internal business partner
+ Represent department in external meetings (e.g., ancillary providers; physician groups; facilities) to gather relevant information, recommend solutions, execute on deliverables as assigned and explain results/decision/activities
+ Monitor and/or oversee provider financial performance to identify opportunities to improve performance and/or provider relationship
+ Monitor and/or oversee network performance and industry trends to identify opportunities to refine, develop, and/or implement market strategies
+ Other duties as assigned
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:
+ 3+ years of experience with PBM or pharmacy contract management
+ 3+ years of project management experience using data and information to make business decisions
+ Intermediate to advanced level of experience using Excel (pivot tables, V-lookups)
+ Demonstrate understanding of contract language in order to assess financial and operational impact and legal implications of requested contract changes
Preferred Qualifications:
+ Experience with Pharmacy Workers’ Compensation, Cash Card and RFP processes.
+ Experience using Tableau, Power BI, Salesforce
+ Experience with PBM regulatory requirements
+ Experience with Pharmacy rates, pricing analytics
+ Experience working in a highly matrixed/cross-functional environment
+ Experience working with contract negotiations, reimbursement models, and cost models for Pharmacy
+ Demonstrated understanding of and utilize applicable financial tools and reports (e.g., internal financial models; external reports) to develop rates
+ Demonstrated understanding of contract language in order to assess financial and operational impact and legal implications of requested contract changes
+ Demonstrated understanding of competitor landscape within the PBM market (e.g., rates; market share; products; provider networks; market intelligence; GeoAccess)
+ Demonstrated understanding of key pharmacy reimbursement models
+ Demonstrated ability to utilize appropriate contract management systems to author and execute contracts and to access supplemental contractual documents
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C. Residents Only: The salary range for this role is $88,000 to $173,200 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.
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.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
