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 a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: - Oversee formulary builds and maintenance covering all Commercial, Medicaid, and Exchange lines of business (ORx Direct and UHC) - Responsible for commercial formulary program creation & maintenance in the formulary application - Support short and long term operational and strategic business activities - by developing, enhancing and maintaining operational information as well as supporting development and maintenance of the Formulary Management applications - Ability to apply clinical knowledge to drug programs and their implementation into formularies - Review and analyze formulary data to determine the appropriate process for building and maintaining formularies in the Formulary Management applications - Oversee formulary change process and perform formulary reporting and analysis functions - Work collaboratively with others to track and maintain formulary information for specific clients - Ensuring a comprehensive quality review of formulary data to maintain accuracy and service level agreements (i.e. Performance Guarantees). The pharmacist who fills this position will participate in all aspects of formulary operations including, but not limited to new formulary implementations, formulary maintenance, implementation of strategic projects, issue review, and related formulary operation activities. You may also research new prescription drugs or new applications of existing drugs and use this information to help guide tier and formulary decisions. This position requires excellent clinical and analytical skills, attention to detail, and the ability to communicate and work collaboratively with other departments. 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: - Current and unrestricted Pharmacy License - 2+ years of experience as a licensed pharmacist - 1+ years of experience with project methodology (requirements, design, development, test and implementation) - Ability to be flexible and work in a dynamic and evolving business environment - Demonstrated process improvement, workflow, benchmarking and / or evaluation of business processes - Proficient level of experience with PC based software programs and automated database management systems (Word, Excel, PowerPoint) - Experience with client formulary data analysis (understanding client intent, review client changes requests, then accurately implementing formulary updates) - Working knowledge of relational databases and database structures Preferred Qualifications: - Pharm D - 2+ years of Pharmacy Benefits Manager (PBM) experience - Experience with VBA macro tools - Formulary Operations and/or Submissions experience - Managed Care experience - RxClaim / AS400 knowledge and experience - Excellent communication, writing, time / project management, problem solving, organizational, and analytical skills - Ability to manage multiple, complex activities simultaneously without compromising quality - Ability to effectively work in collaboration in a team environment to meet client performance guarantees for quality and/or timeliness results *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 to $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.

Role Description The Clinical Operations Manager is responsible for leading and managing clinical operations staff, ensuring accurate and timely review of complex claims by applying clinical knowledge, coding standards, industry expertise, and federal regulations. This role oversees daily operations, supports quality and compliance initiatives, and drives performance to meet client expectations and service level agreements. The incumbent will also provide guidance, training, and mentorship to clinical staff while supporting process improvements and operational efficiencies. Duties - Leads, manages, and develops clinical operations staff, including coding and nursing personnel. - Oversees the review and analysis of complex claims to ensure accuracy, compliance, and adherence to billing standards. - Monitors team performance to ensure productivity, quality, and service level agreements (SLAs) are met. - Provides coaching, training, and mentorship to team members to support development and performance improvement. - Partners with leadership to identify process improvements and implement operational efficiencies. - Ensures compliance with federal regulations, coding standards, and internal policies. - Reviews and analyzes data to identify trends, issues, and opportunities for improvement. - Collaborates with cross-functional teams and stakeholders to support operational goals and client needs. - Supports audits, reporting, and escalation management as needed. - Maintains a high level of customer service and professionalism in all interactions. Qualifications - Minimum high school diploma. Bachelor's degree in healthcare, business, or related field preferred. International education or training is a plus. - Minimum 7 years' experience in a clinically related field including but not limited to: complex hospital and medical billing procedures and coding, auditing, nursing, radiology, laboratory, pharmacy, or a physician assistant position. - Minimum 4 years' leadership role with people management responsibilities, including managing remote or international teams. - Current coding certification by the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC) or medical license (RN, MD). International certifications or licensure are advantageous. - Extensive knowledge of inpatient/outpatient hospital billing and claims data including UB-04s, revenue codes, itemization of charges, CPT codes, HCPCS codes, ICD-10 diagnoses and procedure codes, DRG, APCs, including international coding systems (e.g., KSA, ICD-10-AM, SNOMED). - Knowledge of Workers' Compensation, Auto, Medicare and government-sponsored programs (such as Medicare or Medicaid). - Knowledge of provider billing and collection practices and international payer systems. - Teaching, mentoring and presentation skills and experience. - Strong communication, managerial, interpersonal, organizational, time management, problem-solving, and leadership skills, with cross-cultural competence. - Ability to commit to providing a level of customer service within established standards. - Ability to analyze data and arrive at a logical conclusion. - Ability to identify issues and determine appropriate course of action for resolution. - Professional demeanor, proper etiquette, and cultural sensitivity in all communications. - Ability to elicit trust and credibility with all levels of the organization. - Ability to use software and hardware related to job responsibilities, including MS Office Suite, online coding tools, and database software. - Ability to work with accuracy in a fast-paced environment. - Ability to adjust/alter workflow to meet deadlines. - Ability to manage highly trained clinical coding and nursing personnel. - Ability to work collegially with healthcare professionals, including physicians. - Ability to work independently and handle confidential information. - Ability to process detailed verbal and written instructions. - Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone. Benefits - Medical, dental and vision coverage with low deductible & copay - Life insurance - Short and long-term disability - Paid Parental Leave - 401(k) + match - Employee Stock Purchase Plan - Generous Paid Time Off – accrued based on years of service - WA Candidates: the accrual rate is 4.61 hours every other week for the first two years of tenure before increasing with additional years of service - 10 paid company holidays - Tuition reimbursement - Flexible Spending Account - Employee Assistance Program - Sick time benefits – for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless the laws of the state in which the employee is located provide for more generous sick time benefits

Job Description General Summary: The Director, Clinical Quality & Development Operations (CQDO) Inspection Excellence is a key contributor in Global Clinical Operations (GCO’s) audit and inspection management program, focusing on GCP health authority inspection planning, logistics, pre and post inspection support, ensuring all activities are conducted in compliance with health authority regulations (e.g. FDA, EMA, etc.). In addition, the Director will also contribute to regulatory intelligence activities, partner with local R&D functions and study teams to create a quality culture within Vertex and help reach a sustained state of inspection readiness. Key Duties and Responsibilities: - Lead inspection readiness and inspection preparation activities for GCO, including SME training/preparation and back-room activities, and manage back-room during GCP inspections. - Analyze the risks, propose the strategy for readiness and manage the implementation of readiness program - Provide lessons learned after each GCP inspection - Participate in internal process audits as needed - Contribute to GCO audit and inspection planning, management and response generation. - In collaboration with Audits and Inspection Management (AIM), develop and approved annual internal audit schedule - Oversee GCO Quality Event management and assist in the development of CAPA plans and investigations in response to audits and inspections. - Ensure inspection findings are remediated, and processes are implemented within GCO. - Oversee management and communication of lessons learned from GCO studies to ensure all functions operate consistently, and develop method for continuous process improvement - Collaborate cross functionally with partners including but not limited to Global Clinical Quality (GCQ), Regulatory Affairs, and Global Patient Safety (GPS). - Advanced leadership and execution of business strategy - Comprehensive understanding of inspection concepts and principles in multiple disciplines and a broad knowledge of others. Oversees multiple projects within domain in support of CQDO deliverables and is a SME for Inspection Excellence domain. - Demonstrated leadership in inspection readiness planning and execution for clinical trial submissions across multiple regulatory agencies, including but not limited to FDA, EMA, MHRA, PMDA, and CDE. - Strong knowledge and demonstrated experience applying risk‑based quality principles (e.g., Quality by Design [QbD]) within a pharmaceutical or regulated environment. - Current and comprehensive knowledge of industry trends, regulatory expectations, and best practices related to progressive quality risk management in a regulated environment. - Drive the development of innovative solutions that address evolving business needs in line with standards - Identifies and resolves technical and operational problems, understands broader impact on the department - Provides strategic input to solve complex problems while exercising judgment using multiple sources of information. - Maintain understanding of the stakeholder landscape and identify areas for alignment across stakeholders. - Communicate clear and convincing opinions, ideas, and positions, tailored to the audience, in a poised, confident, and convincing manner. - Develop solutions that fully address business needs and align standards. - Guides others either internally or externally to adopt a different point of view. - Express views with conviction that gains support from stakeholders, even when they may have a different opinion or when the subject matter is unfamiliar. - Provides mentorship, leadership and guidance to junior level staff or Functional Service Provider (FSP) personnel. - As a people manager within the organization, may have financial accountabilities and human resource responsibilities for assigned staff Knowledge and Skills: - Advanced understanding of GCP, CFR and ICH guidelines and Health Authority regulations - Advanced ability to leverage knowledge of organizational goals and interdependencies with other functional areas to drive success - Significant experience managing clinical quality activities and in-depth knowledge of clinical operations - Lead cross-functional projects of high complexity with cross-functional team members and represent Clinical Quality & Development Operations on other large-scale projects/initiatives. - Executes strategy for Inspections Excellence in alignment with Clinical Quality & Development Operations (CQDO), Global Clinical Operations, and Global Medicines Development & Medical Affairs program strategy and goals - Leads major projects in support of GCO infrastructure and makes department-wide decisions. - Demonstrated attention to detail, accuracy, excellent review and analytical skills in a fast-paced environment. - Expert knowledge in system/technical tools and processes. - Results oriented - Significant experience with line management of employees - Excellent leadership and interpersonal skills with an ability to effectively work and problem solve within a multidisciplinary team - Experience in collaborating and working with global and cross-functional teams - Excellent oral and written communication skills to influence, inform, or guide others and to communicate complex concepts - Demonstrated adaptability, flexibility, independence and resourcefulness to thrive in a mid-sized company environment - Proven successful track record in maintaining knowledge and compliance of regulatory requirements Education and Experience: - Typically requires 10 years of experience, or the equivalent combination of education and experience, in the biopharmaceutical industry - 3 years of supervisor/management experience Pay Range: $184,000 - $276,000 Disclosure Statement: The range provided is based on what we believe is a reasonable estimate for the base salary pay range for this job at the time of posting. This role is eligible for an annual bonus and annual equity awards. Some roles may also be eligible for overtime pay, in accordance with federal and state requirements. Actual base salary pay will be based on a number of factors, including skills, competencies, experience, and other job-related factors permitted by law. At Vertex, our Total Rewards offerings also include inclusive market-leading benefits to meet our employees wherever they are in their career, financial, family and wellbeing journey while providing flexibility and resources to support their growth and aspirations. From medical, dental and vision benefits to generous paid time off (including a week-long company shutdown in the Summer and the Winter), educational assistance programs including student loan repayment, a generous commuting subsidy, matching charitable donations, 401(k) and so much more. Flex Designation: Remote-Eligible Flex Eligibility Status: In this Remote-Eligible role, you can choose to be designated as: 1. Remote: work remotely five days per week and come into the office on occasion – you’re always welcome on-site; or select 2. Hybrid: work remotely up to two days per week; or select 3. On-Site: work five days per week on-site with ad hoc flexibility. Note: The Flex status for this position is subject to Vertex’s Policy on Flex @ Vertex Program and may be changed at any time. #LI-Remote Company Information Vertex is a global biotechnology company that invests in scientific innovation. Vertex is committed to equal employment opportunity and non-discrimination for all employees and qualified applicants without regard to a person's race, color, sex, gender identity or expression, age, religion, national origin, ancestry, ethnicity, disability, veteran status, genetic information, sexual orientation, marital status, or any characteristic protected under applicable law. Vertex is an E-Verify Employer in the United States. Vertex will make reasonable accommodations for qualified individuals with known disabilities, in accordance with applicable law. Any applicant requiring an accommodation in connection with the hiring process and/or to perform the essential functions of the position for which the applicant has applied should make a request to the recruiter or hiring manager, or contact Talent Acquisition at ApplicationAssistance@vrtx.com

Imagine360 is currently seeking a Registered Dietitian, Care Coach to join the team! The Care Coach is responsible for providing telephonic coaching and educational resources to people with chronic health conditions. Coaching topics include medication compliance, nutrition, physical activity, and care coordination. Responsibilities include assessment, coordination, planning, monitoring, and evaluation. Position Location: 100% Remote Responsibilities include but are not limited to: - Provide telephonic coaching, and information and referral services to program participants managing various chronic health conditions with clinical oversight assistance - Assess participant needs using scripted assessments - Communicate, as needed, with service delivery partners, physicians, and other health professionals to provide care coordination - Review pertinent medical history, current diagnosis, and pharmaceutical data via information database system with clinical oversight - Assist participant in forming realistic goals related to overall health - Determine and provide relevant community and/or healthcare resources that help support participant's goals - Promote wellness and provide education regarding preventative care measures - Effectively assess, coach and graduate clients from care, resulting in appropriately managed caseloads - Document participant activities and coaching/counseling sessions in established format in the case tracking software In addition to performing standard Care Coach roles, the Registered Dietitian is involved in clinical decision-making and patient education. The scope of practice for dietetic work includes, but is not limited to: - Nutrition assessment - initial data collection and reassessment. Evaluate dietary intake, health and disease conditions for nutrition related consequences. - Nutrition diagnosis - Derive nutrition diagnosis from assessment data. - Nutrition intervention - Ensures nutrition plan content is based on the best available evidence. - Implement measures to promote a safe environment for clients and others - Respect the client's right to privacy by protecting confidential information - Promote and participate in education to a participant based on health needs - Clarify any treatment that is believed to be inaccurate, non-efficacious, or contraindicated by consulting with an appropriate practitioner - Know, recognize, and maintain professional boundaries of the nurse-client relationship The Registered Dietitian will be a Certified Diabetes Care and Education Specialist. The Scope of Practice for Certified Diabetes Care and Education (CDCES) includes, but is not limited to: - Individualized assessment and education plan developed collaboratively by the individual and educator(s) to direct the selection of appropriate educational interventions and self-management support strategies. - Educational interventions directed toward helping the individual achieve self­ management goals - Periodic evaluations to determine attainment of educational objectives or need for additional interventions and future reassessments - A personalized follow-up plan developed collaboratively by the individual and educator(s) for ongoing self-management support - Documentation in the education record of the assessment and education plan and the intervention and outcomes - Knowledge in lifestyle counseling as is related to diabetes care Required Experience / Education: - Dietitian master's degree from an accredited college or university - Current, active, and unrestricted Registered Dietitian license. - Certified Diabetes Care and Education Specialist (CDCES) certification is required - 2+ years of experience in direct participant coaching required - Must have intermediate knowledge and skills using Microsoft Office including Word, Excel, and PowerPoint software; Internet software; Database software What can Imagine360 offer you? - Multiple Health Plan Options - Company paid employee premiums for disability and life insurance - Parental Leave Policy - 20 days PTO to start / 10 Paid Holidays - Tuition reimbursement - 401k Company contribution - Professional development initiatives / continuous learning opportunities - Opportunities to participate in and support the company's diversity and inclusion initiatives   Want to see our latest job opportunities? Follow us on LinkedIn Imagine360 is a health plan solution company that combines 50+ years of self-funding healthcare expertise. Over the years, we've helped thousands of employers save billions on healthcare. Our breakthrough total health plan solution is fixing today's one-size-fits-none PPO insurance problems with powerful, customized, member-focused solutions. Imagine360 is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. **RECRUITMENT AGENCIES PLEASE NOTE: Imagine360 will only accept applications from agencies/business partners that have been invited to work on a specific role. Candidate Resumes/CV's submitted without permission or directly to Hiring Managers will be considered unsolicited and no fee will be payable. Thank you for your cooperation**