Optum Rx AI Capability Lead

UnitedHealth Group•Eden Prairie, MN

2d•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 more you do, the more you learn. And as you learn you find new doors opening that challenge you to bring your best. This role with UnitedHealth Group will call on your knowledge, your energy and your commitment to making health care work more effectively for more people. Today, more and more employers are turning to us for innovative ideas and high levels of performance. Now, we invite you to help us harness the power of Artificial Intelligence to improve experiences for our stakeholders. You’ll be responsible for strategic alignment of AI initiatives with business goals, ensuring that talent contributes to the organization's growth, efficiency, and competitive advantage. Along the way, you’ll discover the training, resources and opportunities you’d expect from a Fortune 10 leader. 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. This is a challenging role with serious impact. It’s a fast paced, high-volume environment that requires you to work independently while maintaining a strong focus on company policies and guidelines. Your accuracy will be vitally important and monitored carefully to ensure our system is correctly coded and that all plan documents are precise. 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.

Requirements

5+ years of experience in underwriting, finance, healthcare, product development, capability management, and/or technical experience in the healthcare domain (preferably pharmacy)
2+ years of experience analyzing data, understanding key performance indicators, and translating into vision/action
Experience validating reporting and benefit realization for stakeholders
Experience adapting to new technologies and processes quickly
High level of self-management and accountability to ensure tasks are completed efficiently and effectively
Solid problem-solving skills to address and action issues
Ability to follow emerging technology and solutions being introduced into market by technology leaders. (Microsoft, Google, OpenAI, Amazon, etc.)
High level of accuracy and attention to detail
High proficiency in Microsoft office suite

Nice To Haves

Experience in pharmacy benefit management (PBM) or pharmacy
Experience in Agile product leadership experience
Experience communicating and presenting to executive leadership, telling the story around solutions and their impact
Python library experience
Experience in implementing Artificial Intelligence large scale projects
Experience with OptumRx PBM and Pharmacy applications (RxClaim, IRIS)
Solid understanding of regulatory bodies and requirements (CMS, ERISA, etc.)

Responsibilities

Ensuring Strategic Alignment
Business Acumen: Understanding the broader business context and how AI initiatives can support strategic objectives. This includes knowledge of market trends, customer needs, and competitive landscape
Acknowledge failure: Learn from AI efforts that fail and close out effort. Not all ideas are successful
Healthcare landscape: Understands the journey in healthcare from patient, provider, pharmacy, plan sponsor, and plan administrator
Value Creation: Ability to identify and prioritize AI projects that deliver tangible business benefits, such as increased quality, cost savings, revenue growth, and improved customer experiences
Innovation and Problem-Solving
Technical Understanding: Understands AI models and frameworks such as machine learning, generative AI, retrieval augmented generation, agentic, custom trained models, etc. Understanding data quality, data orchestration, training data, testing data, and validation data. Understanding of core programming languages used for AI. (ie; Python, Java) Able to adapt as new AI models and frameworks become available
Innovative Thinking: Understands the importance of thinking outside of the artificial boundaries created by applications and processes. Thinks within the framework of delivering positive outcomes for stakeholders within the healthcare ecosystem and ensuring quality and compliance. Comfortable presenting reshaped experiences for stakeholders with less abrasion. Able to create a vision and plan for AI strategies. Enables data to test a hypothesis even while there can be skepticism from the broader team
Success Criteria: Understands best practices on establishing success criteria to measure AI performance. (ie, accuracy, context, false positives, etc.)
AI is not always a fit: Understands that AI is not always the best solution. (ie; using advanced analytics, traditional rules, etc.)
Data-Driven Decision Making: Utilizing data insights to inform business strategies and decisions. This includes the ability to interpret data patterns and translate them into actionable steps
Self-study: Monitors market for new trends and AI tools becoming available
Repurposing: Able to identify solutions that have been previously completed that could support in solving an additional business problem. (create once and use many)
Leadership and Collaboration
Matrix Environment: Able to work cross functionally to influence and engage stakeholders
Communication: Ability to bridge technical and non-technical teams, translates ideas into actionable steps
Expectations: Ability to establish expectations across stakeholders to ensure buy in and alignment
Change Management: Leading and managing change initiatives related to AI adoption. This includes addressing resistance, ensuring stakeholder buy-in, and facilitating smooth transitions
Ethical and Responsible AI Use
Ethical Considerations: Ensuring that AI applications adhere to ethical standards and are being used responsibly. This includes maintaining data privacy, fairness, compliance, and transparency in AI solutions
Human Oversight: Ensures AI solutions have monitoring in place for performance and fairness
No Harm: Ensures AI solutions are not leveraged in areas where there can be potential harm
Regulatory requirements: Ability to understand in healthcare where there are requirements on who can adjudicate an outcome. (ie; MD, RN, RPh) Understands governing bodies across lines of business to ensure correct stakeholders review AI solution
Artificial Intelligence Review Board (AIRB): Ensures all AI related projects obtain approval from UHG AIRB prior to being put into production. Ensures documentation and testing requirements are satisfied prior to submission. Performs outreach to AIRB in areas not fully defined within AIRB framework
Governance: Ensures AI solutions have established governance process for ongoing monitoring and surveillance