Associate Director- Network Programs
Job Description:
About the Role
In healthcare, evolution doesn't just happen. It takes innovation, imagination, and a passion for solving problems in new and better ways. And innovation is taking place at a lightning-fast pace every day at Optum.
Your Responsibilities
1. Drive development of the Prescription Drug Lists (PDLs) including strategy and coverage decisions for medications covered under both the pharmacy and medical benefit.
2. Collaborate effectively with analytic team to identify opportunities, determine impact of decisions, and monitor results.
3. Work in conjunction with UHC PDL clinical, operations, and medical teams to identify, align, and implement strategies.
4. In collaboration with enterprise partners, obtain and evaluate discounts from pharmaceutical manufacturers to deliver value.
Primary Responsibilities
1. Drive development of the PDLs and accompanying programs for the Commercial business to achieve affordability and savings targets, manage trend and improve quality for approximately 14M covered lives.
2. Drive development of coverage strategies for medications covered under the medical benefit to achieve affordability and savings targets, manage trend and improve quality for approximately 22M covered lives.
3. Work in conjunction with PBM to develop strategies, as appropriate, and obtain industry-leading pricing for drugs covered under both the pharmacy and medical benefit.
4. Collaborate with team providing analytics, e.g. mine claims data to understand current utilization patterns, develop and modify models to estimate financial impact of various coverage strategies, track and evaluate outcomes of PDL placement, utilization management and other programs.
5. Represent PDL strategies to internal and external stakeholders (including key senior leaders) to gain support, including providing evidence of underlying need or opportunity, rationale for decisions and expected impact of any changes.
6. Monitor US healthcare market with respect to assigned therapeutic areas and serve as subject matter expert on upcoming market events, trends, risks, and opportunities.
7. Demonstrate clinical understanding of drug / therapeutic categories for strategy assignments, including clinical drug guidelines and UHC Pharmacy & Therapeutics Committee clinical designations.
Requirements
* Bachelor's degree
* Experience leading initiatives that contribute to measurable financial impact, especially cross-functional efforts involving multiple business units
* Excellent verbal and written communication skills; ability to speak clearly and concisely, ability to understand, interpret, and convey complex technical information in an audience-specific manner
* Strong interpersonal skills, history of establishing rapport and working well with both internal and external colleagues
* Proven ability to work collaboratively with multiple teams or departments to problem-solve and support achievement of business goals
* Intermediate MS Office Excel skills (e.g. V-lookups and Pivot tables)