Note: The job is a remote job and is open to candidates in USA. Optum is a global healthcare organization that uses technology to improve health outcomes and deliver integrated pharmacy benefits and consumer health services. The Senior Network Pricing Consultant will lead PBM network pricing analysis, financial modeling, claims and contract analysis, and client performance management while driving process improvements, Agile delivery, and cross-functional transformation initiatives.
Responsibilities
- Lead complex PBM network pricing analysis, financial modeling, scenario evaluation, and unit cost initiatives supporting pharmacy network strategy, client guarantee performance, contract valuation, and executive decision-making
- Serve as a senior subject matter expert for claims, contract, pricing, reimbursement, MAC, network, and utilization data, translating complex findings into clear recommendations and business actions
- Own or lead cross-functional workstreams that improve pricing tools, data products, governance, operating model processes, reporting capabilities, and scalable business controls
- Partner with senior stakeholders across Network Pricing, Data Science, Operations, Product, Technology, Finance, and other business teams to shape priorities, define requirements, resolve issues, and deliver measurable outcomes
- Drive transformation delivery by identifying process gaps, automation opportunities, control weaknesses, and operational risks, then leading practical solutions from discovery through implementation and adoption
- Provide analytical leadership on pricing anomalies, client performance drivers, pharmacy network trends, reimbursement changes, and claims data issues, including root-cause analysis and recommended remediation
- Lead Agile delivery activities for pricing-related capabilities, including backlog refinement, prioritization, requirement definition, user acceptance testing, release readiness, stakeholder communication, and adoption tracking
- Mentor and guide less experienced team members by sharing pricing knowledge, analytical methods, business context, and best practices for stakeholder engagement and delivery execution
- Prepare executive-ready materials, decision summaries, action plans, and status updates that clearly communicate risks, trade-offs, recommendations, and progress against business priorities
Skills
- • 5+ years of analytical experience in financial analysis, health care pricing, PBM network pricing, network management, health care economics, pharmacy benefit management, or a related discipline
- • 5+ years of experience developing, maintaining, or leading financial models, analytical tools, spreadsheets, dashboards, or reporting outputs used to support pricing strategy and business decisions
- • 3+ years of experience leading process improvement, business transformation, operational change, product delivery, or technology-enabled initiatives
- • Demonstrated experience using claims, contract, reimbursement, pricing, utilization, or network data to identify business insights, risks, and improvement opportunities
- • Proven ability to lead cross-functional initiatives, manage competing priorities, influence stakeholders, and drive outcomes in a complex matrixed environment
- • Proven understanding of Agile delivery practices, including requirements definition, backlog management, prioritization, testing, release planning, and adoption support
- • Proven excellent executive communication skills, with the ability to summarize complex analysis, business impacts, risks, and recommendations for senior leaders
- • Proven solid analytical, critical thinking, problem-solving, and decision-making skills, with the ability to operate independently in a fast-paced environment
- • Product Owner, Scrum Master, Project Management, Business Analysis, Lean/Six Sigma, or similar certification
- • Advanced experience in PBM, pharmacy network pricing, reimbursement strategy, contract valuation, MAC pricing, client guarantees, claims analysis, or health care economics
- • Experience leading transformation, product, automation, governance, or operating model initiatives in a pricing, analytics, operations, or technology environment
- • Experience mentoring analysts, consultants, or cross-functional partners on pricing concepts, analytical approaches, process standards, or delivery practices
- • Experience preparing executive-level presentations, business cases, decision papers, or strategic recommendations
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
- Remote work from anywhere within the U.S.
Company Overview
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