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Atlanta, Georgia UnitedHealth Group

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

Director, Government Programs Operations serves as a leader and change driver to support OptumRx's Government Medicaid and HIX Products and Services. The incumbent in this position shall command and cultivate a strong knowledge of CMS regulations and will be accountable for leading and facilitating the organization to develop operating plans. The individual in this position serves as a dynamic leader and facilitator to ensure efficient processes are applied within the operation of Optum's PBM and client base.

This position will drive operational strategy and manage a team that has overall implementation responsibility for their government program area, determining project vision/needs, overseeing system enhancements, and building reliable, repeatable operational processes. Responsibilities include facilitating stakeholders to agree on a prioritized list of system enhancements and working with IT to ensure the portfolio appropriately reflects work that must be completed to maintain compliance with CMS regulations and to support our clients. The team is responsible for supporting Medicaid and HIX-specific operational processes, from inception through post-implementation maintenance.

You'll enjoy the flexibility to telecommute* from anywhere within United States as you take on some tough challenges.

Primary Responsibilities:

  • Operational owner of Medicaid and HIX, and accountable for leading and facilitating the organization to develop operating plans for program related service components, including deliverables, timelines, processes, documentation, communication and training
  • Partner with leaders across the enterprise, including Regulatory, IT, Operations, Account Management and other functional teams to ensure guidance is implemented effectively and operationalized in a manner consistent with requirements and in a fashion that ensures Optum and its clients are compliant and free from operational interruptions. Assume accountability and provide sponsorship for ensuring appropriate handshakes and sign-offs occur across the spectrum to facilitate timely and effective implementation of changes
  • Serve as a catalyst in identifying strategic efforts for evolving needs in OptumRx's Government Programs arena as pertains to our market presence and to implementing OptumRx's response to guidance and plans regarding trends in the industry. Provide frequent and regular suggestions for industry-leading methods of implementing and marketing new Government Programs offerings
  • Manage to a budget and provide direction for governance decisions regarding use of ORx capital budgets
  • Manage a business-prioritized list of system enhancements that will guide IT to allocate resources and ensure the project portfolio appropriately reflects work to be completed for maintaining compliance with CMS and State regulations and to support our clients
  • Demonstrate a strong working knowledge of OptumRx's Government Programs Operation -technology and business - to ensure communication and change facilitation efforts are applicable and tailored to the business and client bases to which they are relevant and that speak to the Government Programs Product as an enterprise technology AND service offering
  • Serve as an operations resource to the organization and its clients in identifying and/or implementing the appropriate solution to a business or compliance need. Manage resource documentation and provide training to the organization on technology and business best practices
  • Participate in industry standards and intelligence groups, representing Government Programs
  • Initiate process and system enhancement changes, as standards evolve, to ensure Optum and its clients are compliant. Utilize participation on industry work groups to drive change to support Optum's position and business model
  • Provide leadership and accountability for the performance and results of the operations team, identifying resources and programs to meet the new demands
  • Ability to escalate issues and work through solutions with enterprise stakeholders
  • Adhere to the established policies and procedures of the Company
  • Perform other duties, as necessary, to meet the objectives of the Company


  • Quick learner with track record for driving teams that are cross-functional (strong matrix management)
  • Proven ability to counsel, influence and find win-win compromise solutions
  • Excellent analytical skills with ability to identify issues and drive the implementation of effective and efficient solutions
  • Superior written and oral communication skills and ability to present strategies, short term tactical and long-term strategic plans
  • Skilled in exercising independent judgment in methods, techniques and evaluation criteria for obtaining results
  • Excellent organizational skills and comfortable with fast paced, changing environment and ambiguity
  • Strong MS Office suite skills including PowerPoint, Word, Excel and Access as well as ability to run and analyze reports

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:

  • Undergraduate degree or equivalent experience
  • 3+ years of experience managing people
  • 3+ years of experience working with Medicare, Medicaid and/or Health Exchange programs
  • 3+ years of Client-Facing experience
  • Broad understanding of pharmacy claims processing and PBM concepts including provider contracting, claims, formulary, and utilization management

Preferred Qualifications:

  • Management experience or higher education in management
  • PBM experience

Careers with OptumRx. We're one of the largest and most innovative pharmacy benefits managers in the US, serving more than 12 million people nationwide. Here you'll fill far more than prescriptions. As a member of one of our pharmacy teams, you're empowered to be your best and do whatever it takes to help each customer. You'll find unrivaled support and training as well as a wealth of growth and development opportunities driven by your performance and limited only by your imagination. Join us. There's no better place to help people live healthier lives while doing your life's best work.(sm)

Colorado Residents Only: The salary range for Colorado residents is $110,200 to $211,700. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords: Director Government Programs Operations, government programs, Medicaid, Medicare, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, Remote, WAH