Senior Capability Manager, Optum Rx Provider Capability Team – 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 Senior Capability Manager will play a pivotal role in advancing Optum Rx’s electronic benefit verification (eBV) initiatives, driving enhanced patient access and streamlined pharmacy benefits processes. This role requires deep cross-functional collaboration, oversight of capital investment processes, strategic vendor partnerships, and regular communication with executive leadership. The ideal candidate is a seasoned program leader with a solid industry understanding of healthcare technology and pharmacy benefit operations.

 

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 end-to-end delivery of the eBV capability roadmap, ensuring timely, high-quality outcomes
• Serve as the primary liaison between business, technology, product, compliance, and clinical teams to align on capability goals
• Monitor KPIs and performance metrics to evaluate capability impact and identify improvement areas
• Drive cross-functional initiatives to optimize electronic benefit verification processes, including integration with internal and external pharmacy systems
• Collaborate with enterprise teams (e.g., IT, Legal, Compliance, Clinical, Product) to resolve roadblocks and maintain alignment
• Facilitate business readiness planning, change management, and operational adoption for new features and enhancements
• Oversee the capital investment process related to eBV initiatives, including business case development, budgeting, and return on investment (ROI) tracking
• Manage financial forecasts and ensure alignment with strategic goals and resource allocations
• Manage relationships with external vendors and partners involved in the delivery of eBV solutions
• Oversee vendor performance, ensure contractual obligations are met, and coordinate with procurement and legal teams as needed
• Evaluate new vendor technologies or enhancements and lead due diligence processes
• Prepare and deliver clear, concise updates and strategic presentations to senior and executive leadership
• Communicate program milestones, risks, and opportunities, translating complex technical topics into business value language
• Act as a thought leader and advocate for eBV innovation internally and externally

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:

• 6+ years of experience in program management, healthcare operations, and/or pharmacy benefit management
• Proven success managing large-scale cross-functional initiatives
• Familiarity with pharmacy workflows, benefit verification, and/or PBM operations
• Familiarity in pharmacy distribution models and reimbursement pathways
• Experience in payer policies and prior authorization processes
• Intermediate proficiency in KPI tracking, process optimization, and budget management
• Solid leadership experience managing cross-functional teams (clinical, operations, IT, compliance)

 

Preferred Qualifications:

• Certification in Lean Six Sigma or equivalent process improvement methodology
• Experience translating complex access and reimbursement issues into actionable insights
• Advanced skills in risk management and issue resolution
• Solid relationship-building skills including vendor management 
• Proficiency in stakeholder communication and strategic leadership
• Knowledge of patient assistance programs and/or copay programs
• Knowledge of automation and/or AI capabilities 

 

*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 $110,200 to $188,800 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.