Specialty Biologic Program Manager – Remote

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 Specialty Biologic Program Manager is responsible for advancing patient access and provider support for high-risk specialty medications. This role operates at the intersection of clinical expertise and program management, ensuring both therapy appropriateness and efficient referral-to-treatment execution. The role reports directly to the VP of Provider Experience & Capabilities, with a dotted-line reporting relationship to the VP of Operations for oversight of clinical & therapy-specific responsibilities.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Track patients from referral through treatment, ensuring barriers are resolved quickly and proactively.  
• Act as the liaison between providers, pharma, and patients, ensuring timely communication, education, and program execution.  
• Create and maintain physician-specific reports with status updates for all patients receiving assigned therapies.  
• Provide monthly drug/program-specific reporting to leadership, including conversion rates, pull-through, and KPIs. 
• Participate in the Quality Assurance program to identify and address high-risk/high-volume initiatives.  
• Collaborate with Intake, Reimbursement, and Sales to identify program improvement opportunities (e.g., provider education, claim appeal support processes).  
• Monitor program performance, identify bottlenecks or workflow inefficiencies, and drive resolutions or escalate as needed.  
• Assist with the implementation and training of advanced technology to support program efficiency and scalability. 
• Serve as the drug-specific expert for assigned high-risk biologics, including therapy protocols, payer requirements, and patient access pathways.  
• Conduct clinical reviews to ensure appropriateness of therapy/prescription per company protocol, Medicare, Medicaid, and commercial payer rules.  
•  Perform clinical chart reviews to confirm therapy protocols are followed according to FlexCare, provider, and manufacturer standards.  
• Lead payer and clinical documentation support, including letters of medical necessity (LMNs) and appeals, leveraging provider documentation and clinical resources to advocate for access.  
• Support Intake and the collections team with documentation review and prior authorization, appeal, and medical documentation request requirements to ensure patient pull-through.  
• Partner with manufacturer Patient Services teams to ensure patient support resources are fully utilized before and during treatment

 

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.

Required Qualifications:

• RN with an unrestricted license with compact licensure, or the ability to obtain compact licensure within 6 months.
• 2+ years of Customer service or healthcare sales experience.  
• 1+ year of supervisory/team lead experience
• Proficient in Microsoft Office (Word, Excel, PowerPoint).  

 

Preferred Qualifications:

• Infusion knowledge/experience

 

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

 

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $89,900 to $160,600 annually based on full-time employment. We comply with all minimum wage laws as applicable. 

 

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

 

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes – an enterprise priority reflected in our mission.

 

 

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

 

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.