Optum Prior Authorization Jobs (NOW HIRING)

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.  

At Optum Rx, we are transforming pharmacy care-modernizing how medications are accessed, managed, and delivered to improve outcomes, reduce costs, and create a more seamless experience across members, providers, clients, and pharmacists.

As part of our Senior Leadership Team, this role will lead the OptumRx capability strategy and execution across pharmacy and PBM operations-advancing our ambition to become the most transparent and innovative Pharmacy Care Services organization.

The SVP, Rx Capabilities is a critical Rx leader responsible for enabling large scale transformation across Rx. This role is defining and delivering the capabilities, platforms, and technology investments that enable Optum Rx strategy.

This role drives transformation across the full pharmacy and PBM ecosystem-powering growth, improving quality and speed to therapy, and delivering differentiated experiences through AI, automation, and modern platforms.

The leader will guide the organization toward an intelligent, continuously orchestrated Pharmacy Care Services model, unlocking significant Rx-wide value while enhancing outcomes and experiences at scale.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.  

Primary Responsibilities:

Rx Strategy & Capability Leadership

• Translate Optum Rx strategy into capability roadmaps, technology investments, and delivery plans
• Lead cross-functional alignment across product, operations, clinical, and technology to deliver scalable capabilities
• Ensure delivery of capabilities that support base offerings, new products, and client commitments
• Ensure all capabilities meet federal, state, and contractual regulatory requirements. Lead proactive compliance readiness and execution across evolving healthcare regulations

AI Transformation & Innovation

• Lead the transformation to an AI native Pharmacy and PBM, leveraging AI as the control layer across operations and experiences
• Drive large-scale deployment of AI-powered assistants, digital workforce capabilities, and intelligent automation across member, provider, client, and workforce journeys 
• Establish and execute a multi-year AI roadmap that drives measurable business value and operational transformation

Provider, Consumer, and Client Experience

• Reduce provider abrasion by simplifying prior authorization and integrating workflows into EHR ecosystems
• Enable seamless, digitally driven member and prescriber experiences with transparency, choice, and affordability at the point of care
• Drive Rx-wide efforts to improve NPS and experience outcomes across stakeholders

Operations Modernization

• Lead transformation of PBM and pharmacy operations through automation, platform modernization, and workflow redesign
• Improve throughput, quality, and efficiency by reducing manual effort and optimizing end-to-end workflows
• Deliver measurable operational and financial outcomes through capability investments

Platform & Capability Delivery

• Oversee the development of Rx-wide platforms that power pharmacy and PBM operations (e.g., prior authorization, fulfillment, plan build, pricing)
• Ensure high-quality delivery through strong governance, delivery assurance, and adoption
• Align capital allocation to highest-value initiatives and ensure benefits realization

Financial Performance & Value Realization

• Deliver against Rx value targets, including cost efficiency, growth enablement, and experience improvement
• Manage a large-scale investment portfolio to maximize ROI across AI, operations, and platform transformation
• Enable new AI-driven products and commercialization opportunities

Leadership & Talent Development

• Lead and scale a high-performing organization across strategy, product, operations, and technology disciplines
• Drive a culture of innovation, accountability, and continuous improvement
• Build Rx-wide AI literacy and change management capabilities across the organization

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:

• Bachelor's degree (BS/BA) or equivalent work experience 
• 10 years of executive leadership experience in healthcare, pharmacy, PBM, or related sectors
• Demonstrated success leading large-scale transformation programs across operations and technology. Proven ability to drive AI, automation, or digital transformation at scale
• Experience building and scaling enterprise capabilities, platforms, or product ecosystems
• Solid financial acumen with experience managing large investment portfolios and delivering measurable business value
• Track record of leading large, complex, cross-functional organizations

Preferred Qualifications:

• Deep expertise in PBM operations, pharmacy systems, and provider workflows
• Experience with prior authorization, plan build, pricing, or claims platforms
• Background in AI/ML-driven business transformation and digital workforce models
• Master's degree (MBA, MHA, MPH, or related field) 
• Experience operating within highly regulated healthcare environments

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

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 $225,000 to $375,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.