Associate Director, Medicare Part D Actuarial & Formulary Analysis

UnitedHealth Group•Eden Prairie, MN

3d•$112,700 - $193,200•Remote

About The Position

The Associate Director, Medicare Part D Actuarial & Formulary Analysis is a senior leader responsible for actuarial, financial, and strategic analytics supporting Medicare Part D formulary strategy, drug pipeline management, benefit design, and pharmacy economics. The role maintains OptumRx Medicare benefit and formulary comparison tools using CMS enrollment, formulary, and plan design information, then uses those tools to develop strategies for annual bid support for OptumRx Custom clients and standard Medicare Part D formularies. The position partners with Formulary Strategy, Pharmacy, Clinical, Finance, Medicare Product, Actuarial, P&T, and Government Programs to evaluate the clinical and financial impact of current and emerging pharmaceutical products. It leads financial models and forecasts related to drug pipeline impact, formulary changes, utilization management, rebates, manufacturer pricing, trend, risk adjustment, CMS requirements, and plan profitability. The position may be performed remotely within the U.S.; hires in the Minneapolis or Washington, D.C. area must work in the office at least four days per week. Remote employees must comply with UnitedHealth Group’s Telecommuter Policy.

Requirements

Bachelor’s degree in Actuarial Science, Mathematics, Statistics, Economics, Finance, Pharmacy, or a related quantitative discipline.
At least 5 years of experience in actuarial work, pharmacy analytics, healthcare economics, or Medicare Part D analytics.
Experience with Medicare Part D, pharmacy benefit economics, formulary strategy, or health-plan actuarial analysis.
Experience translating complex quantitative analyses into clear recommendations for senior leadership.
Solid knowledge of Medicare Part D benefit design, CMS requirements, pharmacy trend, utilization, and drug pricing.
Advanced financial modeling and analytical skills.
Solid leadership, communication, and presentation skills.

Nice To Haves

ASA/FSA designation or significant progress toward actuarial credentials.
Advanced Tableau programming experience.
Experience with formulary development, P&T processes, or pharmacy benefit management.
Experience forecasting specialty pharmaceuticals and emerging drug pipelines.
Knowledge of CMS bid development, Part D pricing, risk adjustment, and plan financial forecasting.

Responsibilities

Provide actuarial and financial recommendations for standard and custom Medicare formulary strategy and P&T decision-making.
Evaluate the economics of alternative formulary strategies and preferred products.
Quantify how formulary changes affect drug trend, member disruption, utilization, rebates, and plan economics.
Support financial strategies for high-cost specialty drugs, GLP-1 therapies, gene therapies, biosimilars, and other high-impact products.
Establish financial thresholds and analytical frameworks for formulary decisions.
Monitor and assess the financial impact of CMS Medicare Part D regulations and program requirements.
Analyze changes to Part D benefit structure, including deductible, initial coverage, catastrophic coverage, manufacturer discounts, and plan liability.
Evaluate the financial implications of CMS rate announcements, Part D parameters, and regulatory changes.
Partner with Government Programs and Compliance to ensure analyses reflect applicable CMS requirements.
Lead actuarial analysis of Medicare Part D pharmacy costs, utilization, trend, and emerging drug impact.
Develop PMPM and total pharmacy spend forecasts by therapeutic class, drug, formulary tier, and utilization management strategy.
Analyze the financial impact of formulary positioning, prior authorization, step therapy, quantity limits, exclusions, and preferred products.
Evaluate changes in member cost sharing and benefit design under evolving Part D regulations.
Develop scenario analyses to assess financial risk from high-cost and emerging therapies.
Lead financial forecasts for the pharmaceutical pipeline, including FDA-approved and anticipated products.
Assess the potential Medicare population, clinical indications, expected utilization, market share, pricing, and competitive landscape for emerging therapies.
Quantify the financial impact of new drugs, expanded indications, biosimilars, generics, and major patent expirations.
Develop multi-year forecasts incorporating launch timing, uptake curves, adherence, discontinuation, competition, and pricing assumptions.
Partner with clinical and formulary teams to translate clinical evidence into financial assumptions.
Serve as a senior subject-matter expert on Medicare Part D pharmacy economics and formulary financial strategy.
Lead cross-functional projects involving Actuarial, Finance, Pharmacy, Clinical, Product, and Medicare leadership.
Present complex financial analyses and recommendations to senior executives and leadership committees.
Develop and mentor actuarial and pharmacy analytics professionals.
Establish analytical standards, methodologies, and best practices across the formulary analytics function.
Update and maintain OptumRx Medicare benefit compare and formulary compare tools with CMS enrollment, formulary, and plan design information.
Use benefit and formulary comparison tools to develop annual bid-support strategies for OptumRx Custom clients and standard Medicare Part D formularies.