SVP Payer Relations & Strategy, Pharmacy Care Services (PCS)

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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

The SVP Payer Relations & Strategy is responsible for driving growth and profitability for our Optum Pharmacy Care Services (PCS) businesses through active management of our arrangements with payers and managed care organizations, including health plans, PBMs and at-risk providers. This person will be highly effective at managing a team of leaders who oversee payer/provider negotiations, underwriting, credentialling and compliance, performance guarantees, and client relationships across the breadth of all integrated pharmacies. The ideal candidate will be an experienced, well-connected and respected leader with solid influencing skills who is positioned to evolve the relationships Optum PCS has with key payers towards value-based models and pay-for-performance incentives to capture currently unrealized value due to the void of a singular leadership voice and expertise in this domain.

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

• Lead the vision & execution of plans to create a single Payer function across the entire breadth of Pharmacy Care Services, including upcoming ’25 integrations: CPS & PharmScript, along with the ability to scale with additional non-organic growth opportunities.
• Create and execute new reimbursement models and incentive structures.
• Partner with finance and business leaders to influence and improve forecasting, underwriting and pricing, both with OptumRx PBM as well as external payers, including UHC.
• Develop and lead overall payer contracting strategy and execution including negotiations, contract management, and profitability targets.
• Educate payers and develop the company’s brand and identity to support the mission of a growing, customer focused company.
• Play a critical voice in long range and annual strategic planning for payer value programs include 3–5-year planning cycle and analysis of new business opportunities with solid tie to businesses, Finance and Operations functions
• Improve collaboration across matrix partners, specifically finance, to ensure clear understanding of all Pharmacies business goals and drive to a single payer strategy
• Manage business development initiatives to grow payer based/referral and valued based business.  Lead account management activities.  Deliver against forecasted targets. Oversee incentive programming, quota forecasting and budgeting process.
• Participate with other senior leaders to establish corporate strategic plans and objectives, identifying strategic needs and prioritizing areas of focus to grow revenue
• Develop/Deliver an internal and external covered lives growth strategy, and Support pricing proposals across clients of the PBM and PCS teams
• Develop a solid understanding of Pharmacies value drivers and value proposition to help support negotiation of contracts and drive to pricing that is aligned to Pharmacy value/differentiation
• Direct the strategic development of new pharmacy care programs and value-based initiatives that demonstrate value of integrated pharmacy care model inclusive of coordinating program initiatives across Optum.  
• Develop KPIs for team including profitability improvement and growth in payer networks across all pharmacies
• Define and implement a consistent governance structure, processes, and strategic positioning aligned to ORx strategic plans
• Improve quality of payment processing for primary and secondary payers in partnership with capabilities, technology, and external coupon card vendors.
• Manage pharmacy and medical claims contracting, network management and performance measurement, pharmacy licensing and payer audit activities for all lines of business across all states.
• Keep abreast of state and federal government legislation as well as market dynamics to anticipate industry and payer trends.

Specifically, this leader will be measured on key success factors including:

• Establishing and maintaining broad market access and coverage
• Market share growth
• Profitability of business based on gross margins
• Rightsizing external customer’s P&Ls 
• Advancing our relationship with internal partners such as UHC and Optum Care
• Managing rate pressure and gross margin performance
• Innovating around network structures and the basis of payment 
• Mitigating issues with billing and payment, preventing collection challenges and write offs

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:

• Undergraduate degree
• 15+ years total professional experience, with considerable experience working for a large multi-state healthcare organization
• Demonstrated experience with negotiating direct chain agreements with PBMs and/or other payers/providers
• Demonstrated experience in the design and implementation of innovative care models and products to improve overall quality and affordability, specifically to support better care for complex populations within Medicaid and Medicare programs
• Experience developing relationships within the healthcare industry including, PBMs, health plans, provider groups and Managed care behavioral health organizations; network of relationships at the highest level that can be leveraged
• Demonstrated financial acumen specific to FFS and value-based reimbursement models across pharmacy, medical, and behavioral health services
• Extensive knowledge of Medicare Part D, MAPD, SNPs, and Managed Medicaid reimbursement across Medical, behavioral and pharmacy managed care programs
• Experience negotiating and interfacing with payers within risk-based reimbursement models
• A change agent, transformational leader, and game changer within an organization
• Highly developed relationship-building skills to foster effective working relationships and ability to influence across Optum Rx and the UHG enterprise
• Knowledge of government payer requirements [e.g., Medicare Part B, Medicaid]
• Knowledge of reimbursement dynamics across pharmacy and medical benefits

Preferred Qualifications:

• Advanced degree, Pharm.D. or MBA 

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

The salary range for this role is $250,000 to $350,000 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

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