Medicaid Pharmacy Network Program Manager - Remote

Requisition Number: 2362283
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 Network Program Manager will play a critical leadership role in establishing and scaling regulatory adherence capabilities for the Medicaid line of business within Network Relations. This is a highly visible, build from the ground up opportunity requiring the design, development and execution of new processes, operating models and implementation frameworks to support Medicaid regulatory requirements with a focus on pharmacy network operations and network pricing.
This role will serve as a strategic partner across Legal, Regulatory Affairs, Pricing, Network Operations, and Account Management teams to define how regulatory requirements are interpreted, operationalized, and sustained within a complex and evolving Medicaid landscape.
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 design and implementation of the operating model, processes and governance required to support Medicaid regulatory adherence within Network Relations
• Partner with Medicaid subject matter experts across Regulatory Affairs, Compliance and the broader PBM organization to define strategy and design the operating model, processes, and approach for expanding Medicaid LOB regulatory support
• Establish frameworks for regulatory intake, interpretation, implementation and ongoing compliance monitoring
• Own the full lifecycle of Medicaid regulatory initiatives, including requirement intake, impact assessment, solution design, implementation, and post-implementation validation
• Partner with Pricing, Network Operations, Pharmacy Contracting, and Account Management teams to develop compliant and scalable operational and reimbursement solutions
• Drive alignment across Legal and Regulatory stakeholders to ensure accurate interpretation and execution of requirements
• Define and standardize processes, tools, and documentation to support repeatable and scalable execution
• Manage dependencies, risks, and timelines across a highly matrixed organization
• Develop and deliver executive-level reporting, presentations and recommendations
• Support regulatory audits, external inquiries, and state-specific escalations (e.g., Departments of Insurance, Medicaid agencies)

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:

• 5+ years of experience leading complex, cross-functional programs in a highly matrixed healthcare or regulatory environment
• Experience interpreting and implementing regulatory, legal, or compliance requirements
• Demonstrated experience building or scaling programs, processes, or operational capabilities in ambiguous environments
• Experience developing and delivering executive-level presentations and recommendations
• Advanced proficiency in Microsoft Office Suite (Excel, PowerPoint, Word)
• Proven ability to lead large, cross-functional initiatives with multiple stakeholders and competing priorities

Preferred Qualifications:

• Experience with Medicaid programs, state-specific healthcare regulations or government healthcare lines of business
• PBM, health plan, or healthcare consulting experience including pharmacy network and reimbursement models (e.g., MAC, NADAC, AWP)
• Experience working with Legal and Regulatory Affairs teams to interpret and operationalize legislative requirements
• Experience with Agile or similar delivery methodologies
• Experience with regulatory tracking, workflow, or reporting tools (e.g., SharePoint, eGRC, Smartsheet, Tableau)

Competencies:

• Solid strategic thinking with the ability to translate ambiguity into structured, actionable plans
• Exceptional stakeholder management and influence across senior leadership and cross-functional teams
• Ability to build processes and operating models from the ground up
• Solid program leadership skills with the ability to manage multiple complex initiatives simultaneously
• Excellent written and verbal communication, including executive-level communication
• High level of ownership, accountability and attention to detail
• Adaptability and comfort operating in a fast-paced, evolving regulatory environment

*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 $91,700 - $163,700 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.