Optum Logo

Optum

Formulary Consulting Group Lead - Remote

Posted An Hour Ago
Be an Early Applicant
In-Office or Remote
Hiring Remotely in Irvine, CA
113K-193K Annually
Junior
In-Office or Remote
Hiring Remotely in Irvine, CA
113K-193K Annually
Junior
Provide clinical and financial formulary consulting to clients, analyze claims and pricing data, build financial therapeutic-class models, recommend formulary strategies to achieve clinical and cost-savings goals, create client-facing materials, manage cross-functional deliverables, and serve as subject-matter expert for assigned therapeutic classes. Up to 10% travel.
The summary above was generated by AI
Requisition Number: 2368400
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 talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
This role requires a clinical aptitude to support clients in the growing Formulary Management Services (FMS) business segment, including identification and quantification of opportunities to maximize pharmaceutical rebate revenues and evaluation of these opportunities via financial therapeutic class models using client-specific actual claims data.
Hours: Monday - Friday 8:00 AM - 5:00 PM
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
  • Deliver value to clients through consultations and presentations that focus on formulary strategies to help clients achieve clinical and financial goals
  • Apply clinical and business knowledge to execute financial models to identify formulary strategies yielding payor cost-savings, which will require you to:
    • Evaluate client formularies and UM criteria
    • Read and understand client contracts and pharma contracts
    • Access and use pricing databases, formulary databases, billing databases, claims databases
    • Run, develop, and analyze client utilization and spending reports
  • Develop & present client-facing materials that are clear, concise, and effective; must be able to simplify complex subjects without compromising content
  • Work cross-functionally to understand end-to-end operations, and manage deliverables, expectations and timelines with internal and external partners
  • Contribute to team business objectives
  • Use soft skills to build and foster relationships with internal and external partners
  • Serve as a subject matter expert on assigned therapeutic class strategies
  • Actively pursue continuous quality and process improvement in self and work tasks
  • Up to 10% travel may be required

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:
  • 2+ years of experience in three or more of the following:
  • Client management or client-facing role
  • Formulary operations, strategy, development
  • Clinical operations (P&T, UMs, pipeline)
  • Pharmacy plan design or new client implementation
  • Pharma manufacturer discounts contracting, billing, or modeling
  • Health plan/PBM financial modeling experience

Preferred Qualifications:
  • 5+ years of experience in a client-facing role
  • 3+ years of clinical experience (e.g Pharmacist, Nurse, physician)
  • Possesses excellent communication and interpersonal skills
  • Ability to deal comfortably with ambiguity, uncertainty and risk, and can make high-quality decisions with less than perfect information
  • Ability to change course quickly in a fast-paced environment
  • Ability to demonstrate resourcefulness, and have the ability to innovate and problem-solve with initiative and ingenuity

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 $112,700 - $193,200 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.

Similar Jobs at Optum

An Hour Ago
In-Office or Remote
92K-164K Annually
Senior level
92K-164K Annually
Senior level
Artificial Intelligence • Big Data • Healthtech • Information Technology • Machine Learning • Software • Analytics
Lead end-to-end client onboarding and implementation of pharmacy benefit plans. Serve as primary client contact, coordinate cross-functional teams (formulary, specialty, networks), manage risks and audits, present to stakeholders, track and report implementation status, and mentor implementation team members. Travel 20-25%.
Top Skills: ExcelMicrosoft OutlookMicrosoft PowerpointMicrosoft Word
An Hour Ago
In-Office or Remote
29-52 Hourly
Junior
29-52 Hourly
Junior
Artificial Intelligence • Big Data • Healthtech • Information Technology • Machine Learning • Software • Analytics
Provide telephonic nursing case management: assess, plan, implement, and evaluate care; coordinate discharge and follow-up; coach high-risk patients; document care plans in EHR; collaborate with clinicians and community resources to reduce readmissions.
Top Skills: Electronic Health Record
An Hour Ago
In-Office or Remote
90K-195K Annually
Mid level
90K-195K Annually
Mid level
Artificial Intelligence • Big Data • Healthtech • Information Technology • Machine Learning • Software • Analytics
Manage a portfolio of large national self-funded accounts (5,000+ lives), drive renewal planning, profitability, and growth. Build executive relationships, coordinate cross-functional service delivery, respond to RFPs, present solutions, and monitor client financial performance while maintaining deep product and industry knowledge.

What you need to know about the Boston Tech Scene

Boston is a powerhouse for technology innovation thanks to world-class research universities like MIT and Harvard and a robust pipeline of venture capital investment. Host to the first telephone call and one of the first general-purpose computers ever put into use, Boston is now a hub for biotechnology, robotics and artificial intelligence — though it’s also home to several B2B software giants. So it’s no surprise that the city consistently ranks among the greatest startup ecosystems in the world.

Key Facts About Boston Tech

  • Number of Tech Workers: 269,000; 9.4% of overall workforce (2024 CompTIA survey)
  • Major Tech Employers: Thermo Fisher Scientific, Toast, Klaviyo, HubSpot, DraftKings
  • Key Industries: Artificial intelligence, biotechnology, robotics, software, aerospace
  • Funding Landscape: $15.7 billion in venture capital funding in 2024 (Pitchbook)
  • Notable Investors: Summit Partners, Volition Capital, Bain Capital Ventures, MassVentures, Highland Capital Partners
  • Research Centers and Universities: MIT, Harvard University, Boston College, Tufts University, Boston University, Northeastern University, Smithsonian Astrophysical Observatory, National Bureau of Economic Research, Broad Institute, Lowell Center for Space Science & Technology, National Emerging Infectious Diseases Laboratories

Sign up now Access later

Create Free Account

Please log in or sign up to report this job.

Create Free Account