Senior Director, Medical Contracting and Payer Strategy - Remote

UnitedHealth Group•Atlanta, GA

2d•$134,600 - $230,800•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 Senior Director, Medical Contracting & Payer Strategy is responsible for developing and executing medical contracting strategies that expand payer access, increase covered lives, and improve reimbursement across PCS Pharmacies. This role leads strategic payer relationships, contract negotiations, and market access initiatives with national and regional health plans, employers, and other healthcare stakeholders. Success in this role requires expertise in managed care, medical contracting, network development, and reimbursement strategy, as well as a strong understanding of the interrelationship between medical and pharmacy benefits. 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 in managed care, payer contracting, provider network management, or healthcare strategy
3+ years of direct medical contracting, payer negotiations, or network development experience
Experience working with Commercial, Medicare, and Medicaid health plans
Advanced knowledge of medical reimbursement methodologies, healthcare economics, and managed care principles
Working knowledge of pharmacy benefit design and medical/pharmacy billing and reimbursement dynamics
Demonstrated success developing payer access, network expansion, or reimbursement strategies
Demonstrated solid financial, analytical, negotiation, and relationship management skills
Proven ability to influence stakeholders and lead cross-functional initiatives
Ability and willingness to work at Eastern and Central Time Zone
Ability to travel up to 25%25

Nice To Haves

Experience in specialty pharmacy, infusion pharmacy, pharmacy care services, or provider network contracting
Experience expanding medical payer access and negotiating provider participation agreements
Experience leveraging claims analytics, market intelligence, and financial modeling to support contracting decisions
Experience in business development, consultative sales, or strategic healthcare partnerships
Experience working with large national and regional payers
Knowledge of value-based contracting, alternative reimbursement models, and healthcare market trends
Knowledge of specialty drug reimbursement, site-of-care strategies, and network management
Familiarity with credentialing, accreditation, and provider enrollment processes

Responsibilities

Develop and execute medical contracting and payer access strategies that support growth and reimbursement objectives
Build and manage relationships with national and regional payers, employers, TPAs, and healthcare stakeholders
Negotiate medical participation agreements, reimbursement arrangements, and strategic payer partnerships
Identify growth opportunities through market intelligence, analytics, financial analysis, and out-of-network reporting
Collaborate with Finance, Pricing, Operations, Legal, Compliance, and Account Management to implement and optimize contracts
Monitor payer performance, reimbursement trends, and competitive dynamics to drive access, profitability, and utilization
Provide strategic guidance and subject matter expertise to leadership and cross-functional teams
Represent PCS Pharmacies at key payer, industry, and market access meetings
Maintain awareness of regulatory, legislative, and industry developments affecting reimbursement and network access