5 hours

Prior Authorization Product Manager (Healthcare/PBM) - Telecommute

UnitedHealth Group
Schaumburg, IL
  • Job Code
777496 Prior Authorization Product Manager HealthcarePBM Telecommute

Prior Authorization Product Manager (Healthcare/PBM) - Telecommute (777496)

Position Description

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Key Work and Responsibilities:
  • Receive/respond to RFP/RFI questionnaires on behalf of the Prior Authorization (PA) team
  • Negotiate specific RFP questions and custom operational requests based on feasibility, compliance, operational and financial risk
  • Develop/maintain PA - specific RFP response library
  • Collaborate with Finance/Underwriting/PA Sr. Leadership in developing and managing PA product pricing (i.e.: Fee for Service and PMPM (per member per month) scenarios for PA/Appeal processing, system access, and PA Strategic Products - e.g.: ePA, ePRO, Silent Auth, etc.)
  • Represent PA in PA pricing negotiations with Sales/potential client
  • Communicate RFP/RFI responses and pricing information accordingly
  • Present the overall PA product to clients/prospective clients (e.g.: PA process/workflow, product offerings, oversight, quality, performance, pricing strategy)
  • Travel 20% of time for Best & Final presentations at client sites.
Key decisions this position is responsible for:
  • Define overall strategic direction of PA RFP/RFI responses - workflow/processes, customization, pricing
  • Final approval of all RFP/RFI responses
  • Human Capital deliverables - hiring, performance management, terminations, scheduling
Key Competencies / Capabilities needed to perform this role:
  • Working knowledge of prior authorization process within the PBM industry (Medicare, Medicaid and Commercial) - rationale, formulary/utilization management, pricing
  • Working knowledge of regulatory requirements (federal, state, accreditation bodies) within PBM industry governing the prior authorization process
  • Ability to proactively manage workflow and tasks - prioritization, sense of urgency
  • Autonomous - work independently
  • Flexibility - acute and chronic change management
  • Excellent Communication and presentation skills - clinical, data, projects
  • Ability to comfortably interact with individuals at all levels of an organization within various departments
Performance metrics used for this role:
  • RFP/RFI timelines are met - according to project plan/timeline to respond
  • RFP/RFI responses meet requested need - according to client requirements

Required Qualifications:
  • 3+ years of experience Prior Authorization process within Healthcare / PBM (e.g. Medicare, Medicaid, commercial, etc.)
  • 1+ years of experience working with regulatory requirements (federal, state, accreditation bodies) within PBM industry governing prior authorization, correspondence, and Utilization Management
  • Experience with PAS (Prior Authorization System) - front-end navigation and PA request processing (receipt to notification) - or similar system
  • Intermediate proficiency with Excel and PowerPoint
  • Must be willing and able to travel 20% of time to client sites
Preferred Qualifications:
  • Pharmacist
  • 1+ years of experience working with RFP’s / RFI’s
  • Experience with PBM Sales
  • Experience with project management
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)
*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:  Prior Authorization Product Manager, Prior authorization, healthcare, Pharmacy, Pharmacist, PBM, Medicare, Medicaid, regulatory requirements, governance, RFI, RFP, PAS, Excel, PowerPoint, Telecommute, Remote, Work from home

Job Details

  • Contest Number777496
  • Job TitlePrior Authorization Product Manager (Healthcare/PBM) - Telecommute
  • Job FamilyBusiness Operations
  • Business SegmentOptumRx

Job Location Information

  • Schaumburg, IL
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelDirector
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionYes
  • Overtime StatusExempt


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Prior Authorization Product Manager (Healthcare/PBM) - Telecommute

UnitedHealth Group
Schaumburg, IL

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Prior Authorization Product Manager (Healthcare/PBM) - Telecommute

UnitedHealth Group
Schaumburg, IL

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