Optum is a global organisation 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.
About Us
We have a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. We make an impact on the communities we serve as we advance health equity on a global scale.
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. At Optum, we're constantly innovating and pushing the boundaries of what's possible.
We're expanding our team in Ireland and creating excellent opportunities for those who want greater purpose and more impact in their work. We'll provide the investment, support, and resources to advance your career. You'll provide the talent, ambition, and drive.
Job Description
You will be responsible for driving development of United HealthCare formularies or Prescription Drug Lists (PDLs). You will lead coverage and utilization management decisions for pharmacy and medical benefit drugs based on financial modelling and strategic analysis.
To achieve these goals, you will build relationships with cross-functional stakeholders including Clinical, Finance, Legal, and OptumRx Industry Relations teams.
Key Responsibilities
* Drive development of the PDLs and accompanying utilization management programs for the Commercial business to achieve affordability and savings targets, manage trend and improve quality for approximately 14M covered lives.
* 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.
* Work in conjunction with PBM to develop formulary management strategies, as appropriate, and obtain industry-leading pricing for drugs covered under both the pharmacy and medical benefit.
* 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.
* 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.
* Monitor US healthcare market with respect to assigned therapeutic areas and serve as subject matter expert on upcoming market events, trends, risks, and opportunities.
* Demonstrate clinical understanding of drug / therapeutic categories for assigned classes, 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)
Preferred Qualifications
* Advanced degree (MBA, PharmD, MS) and/or bachelor's degree in pharmacy
* Experience in strategy development and proficiency in performing financial impact analysis using financial, forecasting and other data analysis tools
* Experience working in managed health care, pharmacy benefit management, and/or pharmaceutical industry
* Experience with data visualization tools such as Tableau or Power BI