Senior Manager of Pharmacy Audit, Medicaid – Indianapolis, IN, Telecommute with Client Facing

Careers at UnitedHealth Group


We’re creating opportunities in every corner of the health care marketplace to improve lives while we’re building careers. At UnitedHealth Group, we support you with the latest tools, advanced training and the combined strength of high caliber co-workers who share your passion, your energy and your commitment to quality. Join us and start doing your life’s best work. SM




Compassion. It’s the starting point for health care providers like you and it’s what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you’re also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life’s best work. SM


Our teams are helping people from around the world. We can bring out your best as you put your listening, analytical and problem solving skills to work in a setting that is geared to helping improve lives and enhance health care for millions. Here, you’ll discover a wealth of pathways for professional growth within Customer Service, Billing, Claims, Enrollment & Eligibility and across our global economy. Join us and find out why this is the place to do your life’s best work. SM


Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that’s improving the lives of millions. Here, innovation isn’t about another gadget, it’s about making health care data available wherever and whenever people need it, safely and reliably. There’s no room for error. Join us and start doing your life’s best work.(sm)


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


Primary Responsibilities:

  • Lead diverse team of investigators and analysts in pursuit of FWA identification
  • Responsible for administering audit plan for the state
  • Drive resolution to key pharmacy audit escalations across business partners such as network compliance and relations, finance, Medicaid Fraud Control Unit
  • Collaborate on proactive solutions with key clients, client services, and legal team related to FWA matters
  • Serve as central point of contact and subject matter expert for FWA for the state
  • Anticipate client’s needs and proactively builds relationship through ongoing meetings, presentations, escalations, and resolution of issues
  • Design policy and procedures around new FWA initiatives
  • Direct responsibility for metrics, recoveries, and IOI generated under program for key clients
  • Assesses and interprets pharmacy audit requirements and needs of client / client account management
  • Collaborate with, and present to, senior business leaders to deliver highlights of emerging FWA trends
  • Adapts department plans and priorities to address business and operational challenges
  • Create and execute audit communication plans for the state and providers
  • Ensure that recoupment is collected in a timely, accurate manner and in accordance with State policies
  • Participate in all State, provider or member meetings as requested by the State
  • Provide expert testimony, on behalf of the state, at Administrative Law Judge Hearings
  • Excellent verbal and written communication skills

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, or higher. Equivalent work experience will be considered
  • Indiana State Pharmacy Technician Licensure or Indiana Pharmacist License (or ability to obtain within 90 days of hire)
  • National Pharmacy Technician Certification or licensed Pharmacist
  • 5+ years of experience in Pharmacy or Healthcare industry, preferably PBM
  • 2+ years of relevant experience managing a team and/or managing a client
  • Proficiency utilizing MS Office: Word, Excel, PowerPoint, and Outlook
  • Experience with data analysis and manipulation of data
  • Ability to travel up to 15% (For applicants within commutable distance to Indianapolis travel would be 5%)
  • Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance

Preferred Qualifications:

  • Bachelor’s degree in health care administration, nursing, health information administration or related field
  • Certified Fraud Examiner and/or Registered Health Information Administrator
  • Pharmacy or healthcare audit experience
  • PBM experience
  • Experience managing a client
  • Advanced Excel proficiency
  • Medicaid claims processing, data management, pharmacy practices, and the Indiana Medicaid program
  • Organized with effective and persuasive communication skills

Demonstrated Skills:

  • Highly flexible, open to change and new information
  • Demonstrated leadership of team and bench strength development
  • Manages ambiguity, adapting behavior and work methods to changing organization, adapting best practices in all processes
  • Establishes trust and credibility and follows through on commitments
  • Effective data analysis and interpretation skills
  • Ability to focus on key metrics and frame their overall impact on business objectives
  • Uses careful listening, tact, and candor in all communication
  • Demonstrated problem solving skills; ability to dig into the details
  • High employee engagement and manger index/values
  • Excellent presentation skills

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.


Careers with OptumRx. We’re one of the largest and most innovative pharmacy benefits managers in the US, serving more than 12 million people nationwide. Here you’ll fill far more than prescriptions. As a member of one of our pharmacy teams, you’re empowered to be your best and do whatever it takes to help each customer. You’ll find unrivaled support and training as well as a wealth of growth and development opportunities driven by your performance and limited only by your imagination. Join us. There’s no better place to help people live healthier lives while doing your life’s best work.(sm)


*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.


Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.


UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.


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