Remote Utilization Management Jobs in Birmingham, AL

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.

The Director, Patient Access Strategy & Therapy Portfolio is responsible for aligning patient access operations, therapy utilization, and clinical workflows to ensure patients receive sustainable care across ambulatory infusion locations. This role bridges intake, clinical, and reimbursement considerations to shape access pathways and therapy decisions that support both patient experience and organizational priorities. The Director serves as a key liaison across FlexCare, Optum Intake, and Optum Revenue Cycle Management to ensure consistent execution of intake processes, benefit coordination, and therapy routing logic.

In addition to guiding therapy portfolio strategy, including therapy conversion, biosimilar adoption, site-of care alignment, and utilization management, the role identifies opportunities to improve how patients are routed, evaluated, and supported through their treatment journey. The role leverages data, operational insight, and payer knowledge to inform decisions, develop practical recommendations, and drive cross-functional initiatives that enhance access efficiency and therapy alignment. Through collaboration and structured execution, the Director ensures continuous improvement of therapy mix, access workflows, and overall care delivery performance.

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:

• Patient Access Strategy & Clinical Coordination
  • Partner with intake and navigation teams to refine routing logic, workflows, and decision rules that support optimal therapy selection and financial outcomes
  • Liaise across FlexCare, Optum Intake, and Optum RCM to ensure alignment on:
    • Financial assistance programs
    • Free drug eligibility and capture
    • Therapy intake decisions and downstream reimbursement implications
  • Provide oversight of RN clinical reviewers to ensure:
    • Clinical appropriateness of therapy conversions
    • Alignment between clinical review and intake workflows
    • Consistent application of substitution protocols and payer requirements
  • Support development and maintenance of standardized protocols for therapy selection, substitution, and access pathways
• Therapy Portfolio Management
  • Maintain oversight of therapy mix and portfolio performance across ambulatory infusion services
    • Own execution of therapy optimization initiatives, including defining scope, timelines, milestones, success metrics, and risk mitigation plans
    • Facilitate alignment across clinical, operational, and financial stakeholders
    • Ensure accountability for deliverables and sustained execution of initiatives
    • Track initiative performance and provide executive-level updates and recommendations
  • Evaluate existing therapies and identify opportunities for:
    • Therapy conversion (including clinically equivalent alternatives and biosimilars)
    • Site-of-care optimization
    • Drug utilization efficiency
  • Develop and present business cases for therapy transitions, payer strategy adjustments, and margin improvement initiatives
  • Monitor financial performance of high-cost medications and therapy categories, including identification of margin risk and leakage
  • Partner with procurement, finance, contracting, and revenue cycle teams to implement revenue protection and margin improvement strategies
• Patient Access & Benefit Channel Expertise
  • Serve as the internal SME on medical and pharmacy benefit structures for infusion therapies
  • Analyze payer policies, authorization requirements, reimbursement methodologies, and coverage rules to inform access strategy and therapy selection
  • Identify opportunities to improve benefit investigation accuracy, payer routing, and authorization outcomes
  • Collaborate with reimbursement, prior authorization, and intake teams to resolve coverage barriers and delays in therapy initiation
  • Maintain ongoing awareness of payer policy changes that may impact revenue, access, or therapy utilization

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:

• 5 years of experience in patient access for infusion and pharmacy
• 5 years of experience in ambulatory infusion and/or specialty pharmacy operations
• 3 years of management experience
•  

Preferred Qualifications:

• Associate or bachelor's degree in healthcare, business, or related discipline
• Proficiency with WeInfuse and Asana

*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 $91,700 - $163,700 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.