Senior Capability Manager, Provider Capabilities

Optum; Eden Prairie (MN); Hybrid; USD 113,000 - 193,000; Full time

Job summary

Optum is seeking a Senior Capability Manager to lead the strategy and roadmap for clinical data exchange capabilities across Optum Rx. You will partner with sponsors to define use cases, secure funding, and drive execution across technology teams and external vendors.

You will translate healthcare business needs into capability requirements, manage data needs, and measure outcomes to improve data availability and operational impact. This role offers remote work within the U.S.

Qualifications

• 5+ years of healthcare industry experience leading complex cross-functional initiatives involving enterprise stakeholders and external vendors.
• Experience with healthcare interoperability and clinical data exchange (FHIR, HL7, NCPDP, health information networks).
• Experience defining capability strategies and roadmaps and translating needs into executable plans and recommendations.

Responsibilities

• Own the strategy, roadmap, priorities, and evolution of Optum Rx clinical data exchange capabilities and use cases.
• Lead cross-functional initiatives across lines of business, enterprise partners, and vendors.
• Collaborate with architecture, engineering, legal, procurement, privacy, and data experts on design, governance, and data-use considerations.
• Identify networks and vendors to acquire data aligned with business needs and funding.

Skills

Leadership

Cross-functional collaboration

Stakeholder management

Healthcare data interoperability

Tools

FHIR

HL7

NCPDP

Job description

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 whileCaring. Connecting. Growing together.

The Senior Capability Manager, Provider Capabilities enables Optum Rx to acquire and use external clinical data for priority business needs. The role works closely with QHINs, clinical data exchange partners, and vendors to make data available and operationally usable across the organization and to evolve clinical data exchange capabilities as business needs and opportunities change. This role sets capability strategy, priorities, and roadmap; partners with business sponsors to define use cases, value, funding needs, and outcomes; and leads cross-functional teams and vendors from opportunity identification through implementation and continuous improvement. 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

• Own the strategy, roadmap, priorities, and ongoing evolution of Optum Rx clinical data exchange capabilities and business use cases
• Partner with business sponsors to prioritize opportunities, refine project scope and value, develop capital funding requests, and secure funding based on feasibility, risk, scalability, data availability, and enterprise alignment
• Translate healthcare business needs into clear capability requirements, data needs, interoperability approaches, success measures, and executable plans
• Lead cross-functional initiatives across Optum Rx lines of business, enterprise partners, technology teams, and external vendors, clarifying ownership, dependencies, decisions, and next steps
• Partner with architecture and engineering on solution design and delivery and with legal, procurement, privacy, security, compliance, and data experts on contracting, governance, regulatory, and data-use considerations
• Identify and manage appropriate networks, vendors, data suppliers, and exchange pathways to acquire data that is available and fit for intended business use cases, including requirements, contracting support, roadmap alignment, implementation, vendor-specific operational processes, and performance
• Communicate complex healthcare interoperability and data concepts in clear business language for technical, non-technical, and executive audiences
• Measure capability success based on data availability and operational usability across intended use cases, and identify opportunities to improve adoption, performance, and business outcomes

Required Qualifications

• 5+ years of healthcare industry experience leading complex, cross-functional business, technology, data, or operational initiatives involving enterprise stakeholders and external vendors
• Experience with healthcare interoperability and clinical data exchange, including working knowledge of FHIR, NCPDP, HL7, health information networks, and/or related standards and solutions
• Experience defining capability strategies and roadmaps and translating business needs, value, risk, data, and governance considerations into executable plans and leadership-ready recommendations

Preferred Qualifications

• Experience with pharmacy, pharmacy benefit management (PBM), prior authorization, medication history, or related provider and pharmacy workflows
• Experience establishing healthcare data partnerships or managing vendors, clinical data suppliers, and/or vendor-specific operational processes
• Experience in Aha! and/or Rally
• Experience using AI tools and resources
• Knowledge of healthcare privacy, security, consent, permitted-use, and data-governance considerations
• 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.