Director, Medicaid Operations and Strategic Initiatives

UnitedHealth Group•Eden Prairie, MN

18h•$112,700 - $193,200•Remote

About The Position

The Director, Medicaid Operations and Strategic Initiatives is an individual contributor role serving as the senior - level liaison to internal partners across Optum Rx and new and existing client accounts. This role will demonstrate cross-functional leadership to drive performance, accountability, and continuous improvement across the Optum Rx Medicaid and Health Exchange (HIX) business. This role serves as a strategic partner to leadership and operational teams, translating strategy into actionable initiatives that strengthen client experience, operational efficiency, and quality outcomes. 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.

Requirements

7+ years of experience in managing complex processes in a PBM or Health Plan.
5+ years of experience working with Government Program Operations including Medicaid and HIX business.
Proven experience in analysis of business processes and workflows, and providing evaluations, and/or process improvement recommendations.
Experience indirectly leading a team, making sound business decisions that support clients needs and regulatory obligations.
Experience interpreting regulatory requirements and initiating business solutions to meet regulatory compliance.
Experience making recommendations and decisions around data file requirements, issues, abnormalities, enhancement needs and process updates.
Demonstrated ability to influence cross-functional stakeholders and drive alignment across teams without direct authority
Exceptional written, verbal, and presentation skills, with the ability to communicate complex ideas clearly to diverse audiences
Solid organizational and time management skills, with the ability to prioritize competing demands and meet deadlines in a fast-paced environment
Solid analytical and problem-solving abilities, with a proven capacity to evaluate challenges, identify root causes, and develop effective solutions
A proactive, critical thinker with strong self-management skills and the ability to work independently while maintaining high standards of accountability

Nice To Haves

5+ years of Optum Rx Implementation or Client Management experience
Expertise in creating SOPs and training documentation
AS400/RXCLAIM experience or experience working in similar claim adjudication systems
Expertise in providing SME support to new product implementations, highlighting operational limitations/options using data to support the direction
Experience is responding to RFP and client questions

Responsibilities

Collaborate with key leaders across the Optum Rx organization to define the strategic direction for operations in support of the Medicaid and HIX lines of business
Document operational processes utilized to support Medicaid and Health Insurance Exchange lines of business and gain alignment on ownership of those processes
Identify opportunities for improvement to existing processes and develop comprehensive strategic operational plans that align with organizational goals
Develop strategies to streamline exiting processes and gain efficiencies though current technology including AI options
Understand regulatory requirements and manage the strategy to ensures processes are in place to meet ongoing compliance needs for our clients
Serve as a Medicaid and HIX subject matter expert during the RFP process, finalist and capability demonstration for prospective clients
Partner across the Government Program Operations team to lead key strategic projects as directed to ensure compliance and operational readiness for assigned initiatives. This includes readiness for the NCPDP D.0 to F6 project through 2028