Associate Director, Medicare Part D Actuarial & Formulary Analysis

Requisition number: 2390165

Job category: Actuarial

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 in making healthcare work better for everyone through people-led, responsible AI while Caring. Connecting. Growing together.

The Associate Director, Medicare Part D Actuarial & Formulary Analysis is a senior leader responsible for providing actuarial, financial, and strategic analytics supporting Medicare Part D formulary strategy, drug pipeline management, benefit design, and overall pharmacy economics.

Update and maintain the OptumRx Medicare benefit compare and formulary compare tools with new enrollment, formulary and plan design information from CMS. Use these tools to develop formulary and benefit design strategies for annual bid support for OptumRx Custom clients and OptumRx standard Medicare Part D formularies.

This role partners closely with Formulary Strategy, Pharmacy, Clinical, Finance, Medicare Product, Actuarial, P&T, and Government Programs to evaluate the clinical and financial impact of current and emerging pharmaceutical products and translate complex drug and utilization trends into actionable formulary and benefit strategies.

The Associate Director will lead the development of sophisticated financial models and forecasts for Part D drug pipeline impact, formulary changes, utilization management strategies, rebates, manufacturer pricing, trend, risk adjustment, CMS requirements, and plan profitability.

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:

• Formulary Strategy

• Provide actuarial and financial recommendations to support formulary strategy for standard and custom Medicare formularies and P&T decision-making

• Evaluate the economics of alternative formulary strategies and preferred products

• Quantify the impact of formulary changes on drug trend, member disruption, utilization, rebates, and overall plan economics

• Support development of financial strategies for high-cost specialty drugs, GLP-1 therapies, gene therapies, biosimilars, and other emerging high-impact products

• Establish financial thresholds and analytical frameworks for formulary decision-making

• CMS & Medicare Part D Analytics

• Monitor and assess the financial impact of changes to CMS Medicare Part D regulations and program requirements

• Analyze changes to the Part D benefit structure, including deductible, initial coverage, catastrophic coverage, manufacturer discounts, and plan liability

• Evaluate the financial implications of CMS rate announcements, Part D parameters, and other regulatory changes

• Partner with Government Programs and Compliance to ensure analyses reflect applicable CMS requirements

• Medicare Part D Actuarial & Financial Analysis

• Lead actuarial analysis of Medicare Part D pharmacy costs, utilization, trend, and emerging drug impact

• Develop forecasts of PMPM and total pharmacy spend by therapeutic class, drug, formulary tier, and utilization management strategy

• Analyze the financial impact of formulary positioning, prior authorization, step therapy, quantity limits, exclusions, and preferred products

• Evaluate changes in member cost sharing and benefit design under evolving Part D regulations

• Develop scenario analyses to assess financial risk associated with high-cost and emerging therapies

• Drug Pipeline & Forecasting

• Lead financial forecasting for the pharmaceutical pipeline, including FDA-approved and anticipated products

• Assess the potential Medicare population, clinical indications, expected utilization, market share, pricing, and competitive landscape for emerging therapies

• Quantify the financial impact of new drugs, expanded indications, biosimilars, generics, and major patent expirations

• Develop multi-year forecasts incorporating drug launch timing, uptake curves, adherence, discontinuation, competition, and pricing assumptions

• Partner with clinical and formulary teams to translate clinical evidence into financial assumptions

• Leadership & Strategic Partnership

• Serve as a senior subject-matter expert on Medicare Part D pharmacy economics and formulary financial strategy

• Lead cross-functional projects involving Actuarial, Finance, Pharmacy, Clinical, Product, and Medicare leadership

• Present complex financial analyses and recommendations to senior executives and leadership committees

• Develop and mentor actuarial and pharmacy analytics professionals

• Establish analytical standards, methodologies, and best practices across the formulary analytics function

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 in Actuarial Science, Mathematics, Statistics, Economics, Finance, Pharmacy, or a related quantitative discipline

• 5+ years of experience in actuarial, pharmacy analytics, healthcare economics, or Medicare Part D analytics

• Experience with Medicare Part D, pharmacy benefit economics, formulary strategy, or health-plan actuarial analysis

• Experience translating complex quantitative analyses into clear recommendations for senior leadership.

• Solid knowledge of Medicare Part D benefit design, CMS requirements, pharmacy trend, utilization, and drug pricing

• Proven advanced financial modeling and analytical skills

• Proven solid leadership, communication, and presentation skills

Preferred Qualifications:

• ASA/FSA designation or significant progress toward actuarial credentials

• Advanced Tableau programming experience

• Experience with formulary development, P&T processes, or pharmacy benefit management

• Experience forecasting specialty pharmaceuticals and emerging drug pipelines

• Knowledge of CMS bid development, Part D pricing, risk adjustment, and plan financial forecasting

Core Competencies

• Medicare Part D actuarial expertise

• Formulary financial strategy

• Pharmaceutical pipeline forecasting

• Pharmacy trend analysis

• Financial modeling

• Drug utilization analytics

• CMS regulatory analysis

• Specialty pharmacy economics

• Strategic decision-making

• Executive communication

• Cross-functional leadership

• Team development

*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 $112,700 - $193,200 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 help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.

UnitedHealth Group and its affiliated brands are 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 and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.