Senior PBM Pricing & Transformation Lead - Remote

Optum; Eden Prairie (MN); On-site; USD 92,000 - 164,000; Full time

Job summary

Optum is seeking a senior professional to join our Network Pricing team in a hybrid role. You will support prescription drug pricing analysis, client performance management, and financial modeling while driving process improvements and data-driven decision making.

You will partner with Network Pricing, Data Science, Operations and technology teams to deliver measurable business outcomes, translating complex data into clear recommendations, and leading pricing-related initiatives across the

Qualifications

• 5+ years of analytical experience in financial analysis, health care pricing, PBM network pricing, network management, health care economics, or related discipline.
• 5+ years of experience developing, maintaining, or leading financial models, analytical tools, 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.

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

Analytical experience

Financial modeling

Cross-functional leadership

Agile delivery practices

Executive communication

Stakeholder management

Tools

Spreadsheets

Dashboards

Reporting tools

Job description

Optum is seeking a senior professional to join our Network Pricing team in a hybrid role. You will support prescription drug pricing analysis, client performance management, and financial modeling while driving process improvements and data-driven decision making.

You will partner with Network Pricing, Data Science, Operations and technology teams to deliver measurable business outcomes, translating complex data into clear recommendations, and leading pricing-related initiatives across the