Director, Medicaid Operations and Strategic Initiatives

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 Director, Medicaid Operations and Strategic Initiatives is an individual contributor role serving as the senior - level liaison to internal partners across Optum Rx and new and existing client accounts.  This role will demonstrate cross-functional leadership to drive performance, accountability, and continuous improvement across the Optum Rx Medicaid and Health Exchange (HIX) business.  This role serves as a strategic partner to leadership and operational teams, translating strategy into actionable initiatives that strengthen client experience, operational efficiency, and quality outcomes.

You'll enjoy the flexibility to work remotely* from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Primary Responsibilities: 

• Collaborate with key leaders across the Optum Rx organization to define the strategic direction for operations in support of the Medicaid and HIX lines of business
• Document operational processes utilized to support Medicaid and Health Insurance Exchange lines of business and gain alignment on ownership of those processes
• Identify opportunities for improvement to existing processes and develop comprehensive strategic operational plans that align with organizational goals
• Develop strategies to streamline exiting processes and gain efficiencies though current technology including AI options
• Understand regulatory requirements and manage the strategy to ensures processes are in place to meet ongoing compliance needs for our clients
• Serve as a Medicaid and HIX subject matter expert during the RFP process, finalist and capability demonstration for prospective clients
• Partner across the Government Program Operations team to lead key strategic projects as directed to ensure compliance and operational readiness for assigned initiatives.  This includes readiness for the NCPDP D.0 to F6 project through 2028

Core Competencies:

• Demonstrated ability to influence cross-functional stakeholders and drive alignment across teams without direct authority
• Exceptional written, verbal, and presentation skills, with the ability to communicate complex ideas clearly to diverse audiences
• Solid organizational and time management skills, with the ability to prioritize competing demands and meet deadlines in a fast-paced environment
• Solid analytical and problem-solving abilities, with a proven capacity to evaluate challenges, identify root causes, and develop effective solutions
• A proactive, critical thinker with strong self-management skills and the ability to work independently while maintaining high standards of accountability

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:  

• 7+ years of experience in managing complex processes in a PBM or Health Plan.
• 5+ years of experience working with Government Program Operations including  Medicaid and HIX business.
• Proven experience in analysis of business processes and workflows, and providing evaluations, and/or process improvement recommendations.
• Experience indirectly leading a team, making sound business decisions that support clients needs and regulatory obligations.
• Experience interpreting regulatory requirements and initiating business solutions to meet regulatory compliance.
• Experience making recommendations and decisions around data file requirements, issues, abnormalities, enhancement needs and process updates.

Preferred Qualifications:

• 5+ years of Optum Rx Implementation or Client Management experience
• Expertise in creating SOPs and training documentation
• AS400/RXCLAIM experience or experience working in similar claim adjudication systems
• Expertise in providing SME support to new product implementations, highlighting operational limitations/options using data to support the direction
• Experience is responding to RFP and client questions

*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 $112,700 to $193,200 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.