M&R Policy Creation Manager

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.

We're in search of an Individual contributor to join our Reimbursement Policy team. As a Policy Manager you will be empowered to develop and maintain UnitedHealthcare policies, cultivate new project initiatives, monitor and research third party sources to ensure UnitedHealthcare's alignment, ensure implementation of coding and edit updates, and identify potential reimbursement opportunities.

Careers with Optum offer flexible work arrangements and individuals who live and work in the Republic of Ireland will have the opportunity to split their monthly work hours between our Dublin or Letterkenny office and telecommuting from a home-based office in a hybrid work model.

Primary Responsibilities:

May include but not limited to:

• Interfacing with other Reimbursement Policy managers to maintain and support reimbursement policies for UHC and ensure accurate and timely implementation of coding and edit updates
• Complete multiple phases as part of reimbursement policy creation and implementation including documentation creation, presentations to large groups, writing business requirement documents
• Analyzing and manipulating large volumes of data
• Providing coding and reimbursement policy expertise to UHC departments
• Ensuring claims are handled accurately in accordance with reimbursement policies
• Review and analysis of third-party publications and resources regarding reimbursement and coding standards
• Represent reimbursement policy functions and processes and provide subject matter expertise on any reimbursement policy related initiatives
• Create and/or maintain materials owned within the department
• Demonstrated ability to work across multifunctional teams
• Consistently drive affordability initiatives impacting multiple business segments
• Develop innovative approaches

You will 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 providing development for other roles you may be interested in.

Required Qualifications:

• High School Diploma or GED
• CPC certification
• Proven experience working in CMS methodology, research, and reimbursement
• Proven experience with CES, ARU, and SAM editing to support payment policy
• Demonstrated working knowledge of claims platforms, including Cosmos, CSP, and/or NICE
• Demonstrated intermediate proficiency in Microsoft Excel and Word, including working with pivot tables, data files, basic formulas, subtotals, data manipulation, document review and tracking changes, adding commentary, and managing heavily formatted documents with embedded tables

Preferred Qualifications:

• Bachelor's degree or higher 
• Proven experience in project management 
• Demonstrated knowledge of Fraud, Waste, and Abuse (FWA) recovery concepts 
• Demonstrated working knowledge of professional and facility claim reimbursement 
• Proven experience writing business requirements 
• Demonstrated proficiency in OneNote and PowerPoint 
• Proven experience designing and/or maintaining CES editing to support reimbursements 
• Proven experience managing multiple projects and affordability initiatives simultaneously 
• Proven experience interpreting financial reports and manipulating data 
• Proven experience in policy writing (e.g., reimbursement policies)

Soft Skills:

• Proven ability to manage and prioritize multiple projects and track affordability initiatives simultaneously 
• Demonstrated solid business writing skills for leadership level summaries 
• Demonstrated ability to effectively liaise with Payment Integrity leadership and cross functional teams 
• Demonstrated solid verbal and written communication skills, with the ability to clearly and concisely articulate information

Please note you must currently be eligible to work and remain indefinitely without any restrictions in the country to which you are making an application. Proof will be required to support your application.  

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: Optum is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to gender, civil status, family status, sexual orientation, disability, religion, age, race, and membership of the Traveller community, or any other characteristic protected by law. Optum is a drug-free workplace. © 2026 Optum Services (Ireland) Limited. All rights reserved.

#BBMEMEA