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 Director, Medical Contracting & Payer Strategy is responsible for developing and executing medical contracting strategies that expand payer access, increase covered lives, and improve reimbursement across PCS Pharmacies. This role leads strategic payer relationships, contract negotiations, and market access initiatives with national and regional health plans, employers, and other healthcare stakeholders.
Success in this role requires expertise in managed care, medical contracting, network development, and reimbursement strategy, as well as a strong understanding of the interrelationship between medical and pharmacy benefits. You'll enjoy the flexibility to work remotely * from anywhere within the U. S. as you take on some tough challenges.
Primary
Develop and execute medical contracting and payer access strategies that support growth and reimbursement objectives Build and manage relationships with national and regional payers, employers, TPAs, and healthcare stakeholders Negotiate medical participation agreements, reimbursement arrangements, and strategic payer partnerships Identify growth opportunities through market intelligence, analytics, financial analysis, and out-of-network reporting Collaborate with Finance, Pricing, Operations, Legal, Compliance, and Account Management to implement and optimize contracts Monitor payer performance, reimbursement trends, and competitive dynamics to drive access, profitability, and utilization Provide strategic guidance and subject matter expertise to leadership and cross-functional teams Represent PCS Pharmacies at key payer, industry, and market access meetings Maintain awareness of regulatory, legislative, and industry developments affecting reimbursement and network access 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
5+ years of experience in managed care, payer contracting, provider network management, or healthcare strategy 3+ years of direct medical contracting, payer negotiations, or network development experience Experience working with Commercial, Medicare, and Medicaid health plans Advanced knowledge of medical reimbursement methodologies, healthcare economics, and managed care principles Working knowledge of pharmacy benefit design and medical/pharmacy billing and reimbursement dynamics Demonstrated success developing payer access, network expansion, or reimbursement strategies Demonstrated solid financial, analytical, negotiation, and relationship management skills Proven ability to influence stakeholders and lead cross-functional initiatives Ability and willingness to work at Eastern and Central Time Zone Ability to travel up to 25%
Experience in specialty pharmacy, infusion pharmacy, pharmacy care services, or provider network contracting Experience expanding medical payer access and negotiating provider participation agreements Experience leveraging claims analytics, market intelligence, and financial modeling to support contracting decisions Experience in business development, consultative sales, or strategic healthcare partnerships Experience working with large national and regional payers Knowledge of value-based contracting, alternative reimbursement models, and healthcare market trends Knowledge of specialty drug reimbursement, site-of-care strategies, and network management Familiarity with credentialing, accreditation, and provider enrollment processes Critical Success Factors Managed Care & Healthcare Market Expertise Medical Contracting & Network Development Strategic Relationship Management Financial & Reimbursement Acumen Sales, Influence & Negotiation Skills Growth & Market Access Strategy Executive Communication Cross-Functional Leadership Analytical & Strategic Decision Making *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 $134,600 - $230,800 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.