Medicaid Pharmacy Network Program Manager - Remote

UnitedHealth Group•Eden Prairie, MN

2d•$91,700 - $163,700•Remote

About The Position

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. The Network Program Manager will play a critical leadership role in establishing and scaling regulatory adherence capabilities for the Medicaid line of business within Network Relations. This is a highly visible, build from the ground up opportunity requiring the design, development and execution of new processes, operating models and implementation frameworks to support Medicaid regulatory requirements with a focus on pharmacy network operations and network pricing. This role will serve as a strategic partner across Legal, Regulatory Affairs, Pricing, Network Operations, and Account Management teams to define how regulatory requirements are interpreted, operationalized, and sustained within a complex and evolving Medicaid landscape. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Requirements

5+ years of experience leading complex, cross-functional programs in a highly matrixed healthcare or regulatory environment
Experience interpreting and implementing regulatory, legal, or compliance requirements
Demonstrated experience building or scaling programs, processes, or operational capabilities in ambiguous environments
Experience developing and delivering executive-level presentations and recommendations
Advanced proficiency in Microsoft Office Suite (Excel, PowerPoint, Word)
Proven ability to lead large, cross-functional initiatives with multiple stakeholders and competing priorities

Nice To Haves

Experience with Medicaid programs, state-specific healthcare regulations or government healthcare lines of business
PBM, health plan, or healthcare consulting experience including pharmacy network and reimbursement models (e.g., MAC, NADAC, AWP)
Experience working with Legal and Regulatory Affairs teams to interpret and operationalize legislative requirements
Experience with Agile or similar delivery methodologies
Experience with regulatory tracking, workflow, or reporting tools (e.g., SharePoint, eGRC, Smartsheet, Tableau)

Responsibilities

Lead the design and implementation of the operating model, processes and governance required to support Medicaid regulatory adherence within Network Relations
Partner with Medicaid subject matter experts across Regulatory Affairs, Compliance and the broader PBM organization to define strategy and design the operating model, processes, and approach for expanding Medicaid LOB regulatory support
Establish frameworks for regulatory intake, interpretation, implementation and ongoing compliance monitoring
Own the full lifecycle of Medicaid regulatory initiatives, including requirement intake, impact assessment, solution design, implementation, and post-implementation validation
Partner with Pricing, Network Operations, Pharmacy Contracting, and Account Management teams to develop compliant and scalable operational and reimbursement solutions
Drive alignment across Legal and Regulatory stakeholders to ensure accurate interpretation and execution of requirements
Define and standardize processes, tools, and documentation to support repeatable and scalable execution
Manage dependencies, risks, and timelines across a highly matrixed organization
Develop and deliver executive-level reporting, presentations and recommendations
Support regulatory audits, external inquiries, and state-specific escalations (e.g., Departments of Insurance, Medicaid agencies)