Medicaid Pharmacy Network Program Manager - Remote

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 a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. The Network Program Manager will play a critical leadership role in establishing and scaling regulatory adherence capabilities for the Medicaid line of business within Network Relations. This is a highly visible, build from the ground up opportunity requiring the design, development and execution of new processes, operating models and implementation frameworks to support Medicaid regulatory requirements with a focus on pharmacy network operations and network pricing. This role will serve as a strategic partner across Legal, Regulatory Affairs, Pricing, Network Operations, and Account Management teams to define how regulatory requirements are interpreted, operationalized, and sustained within a complex and evolving Medicaid landscape. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Lead the design and implementation of the operating model, processes and governance required to support Medicaid regulatory adherence within Network Relations Partner with Medicaid subject matter experts across Regulatory Affairs, Compliance and the broader PBM organization to define strategy and design the operating model, processes, and approach for expanding Medicaid LOB regulatory support Establish frameworks for regulatory intake, interpretation, implementation and ongoing compliance monitoring Own the full lifecycle of Medicaid regulatory initiatives, including requirement intake, impact assessment, solution design, implementation, and post-implementation validation Partner with Pricing, Network Operations, Pharmacy Contracting, and Account Management teams to develop compliant and scalable operational and reimbursement solutions Drive alignment across Legal and Regulatory stakeholders to ensure accurate interpretation and execution of requirements Define and standardize processes, tools, and documentation to support repeatable and scalable execution Manage dependencies, risks, and timelines across a highly matrixed organization Develop and deliver executive-level reporting, presentations and recommendations Support regulatory audits, external inquiries, and state-specific escalations (e.g., Departments of Insurance, Medicaid agencies) 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.

5+ years of experience leading complex, cross-functional programs in a highly matrixed healthcare or regulatory environment Experience interpreting and implementing regulatory, legal, or compliance requirements Demonstrated experience building or scaling programs, processes, or operational capabilities in ambiguous environments Experience developing and delivering executive-level presentations and recommendations Advanced proficiency in Microsoft Office Suite (Excel, PowerPoint, Word) Proven ability to lead large, cross-functional initiatives with multiple stakeholders and competing priorities Preferred Qualifications: Experience with Medicaid programs, state-specific healthcare regulations or government healthcare lines of business PBM, health plan, or healthcare consulting experience including pharmacy network and reimbursement models (e.g., MAC, NADAC, AWP) Experience working with