Clinical Program Consultant - Remote

About the Role

As the Clinical Program Consultant, Affordability Medical Drug Benefit, you will identify and execute affordability opportunities, and execute strategies to address them, including contracting and affordability program development across the commercial book of business. Your overarching focus will be on identifying areas of affordability for drugs managed on our medical benefits. This role will engage with network leadership to define contracting/reimbursement standards and strategies, along with process controls, and support their successful implementation to produce predictable unit cost and trend across our enterprise.

This position will also support clinical UM program implementation and help drive cross-functional collaboration between Network and Pharmacy. You'll partner with leadership across our enterprise, including data and analytics, legal and regulatory, clinical, HCE, network management, and pharmacy experts. This role requires a motivated self-starter who can pivot to adjust to evolving business needs and lead a team effectively. You will engage with enterprise leadership, presenting and gaining support for affordability strategies while focusing on execution and value delivery.

The Associate Director reports to the Director of Medical Benefits, Clinical Strategy within UHC E&I. You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Responsibilities

• Create and drive incremental affordability based on analysis of performance results, opportunity identification, and enterprise business strategies.
• Lead development of affordability program strategies including business requirements, process flows, and implementation, in conjunction with legal/regulatory, clinical, operations, technology, and other key partners.
• Collaborate with other network/affordability leaders to ensure programs and priorities align across the broader enterprise, avoiding redundancy.
• Own contracting affordability program execution from UHC Pharmacy perspective, managing scope, timelines, and stakeholder expectations to drive an integrated value proposition for pharmacy trend and spend.
• Translate affordability strategy into executable tactics with key milestones, responsibilities, and defined dates.
• Work collaboratively with cross-functional teams including clinical and strategy leaders within UHN, clinical team, operations, program management, technology, legal, Optum MBM, and other internal teams to execute the roadmap.
• Establish, analyze, and report key metrics to ensure optimal business results and ongoing performance.
• Communicate and educate the network on relevant network, pharmacy, and regulatory trends, along with competitor offerings.
• Manage competing priorities and work in a fast-paced environment.
• Learn, navigate, and communicate end-to-end processes.

Requirements

• 5+ years of experience in pharmacy and/or facility/provider contracting roles, with a focus on affordability management and development/implementation of drug payment strategies.
• 5+ years of health care industry experience.
• 3+ years of experience in strategy implementation and program operations/development process.
• Demonstrated experience presenting strategic and performance-level information to large audiences.
• Demonstrated expertise influencing to drive decision-making.
• Demonstrated expertise analyzing business data and trends to identify new opportunities for business growth and improvement in provider/member experience.

Preferred Qualifications

• Experience with network and/or product/operations teams.
• Excellent verbal and written communication skills, including proficiency in MS Word, Excel, and PowerPoint.
• High attention to detail, including the ability to manage multiple, competing priorities simultaneously.
• Willingness to roll up your sleeves and do whatever is necessary; owner mentality.
• Demonstrated ability to think strategically and execute methodically.
• Strong interpersonal, communication, and Excel skills.
• Solid analytical, project management, and critical thinking skills.
• Ability to think creatively and comfort being hands-on in a fast-paced environment.

Benefits

In addition to your salary, we offer a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution (all benefits are subject to eligibility requirements).

Pay

The salary for this role will range from $91,700 - $163,700 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, and certifications.