Jobs at Optum

The Bilingual Essential Plan Account Manager manages sales activities to enroll eligible members, build key relationships, and meet sales goals within assigned territory.

Provide hands-on nursing care to senior community care members in facility settings, perform assessments, coordinate with interdisciplinary team and providers, assist with care coordination, medication reconciliation, documentation, therapy coordination, manage acute or sub-acute episodes, and participate in facility meetings and training.

Field-based account manager driving enrollment in the Essential Plan by building relationships with providers, community organizations, and businesses. Conducts outreach, presentations, in-home consultations, pipeline management, data entry in internal systems, and meets sales/enrollment targets across an assigned New York territory.

Field-based sales role to prospect, enroll, and retain eligible members in the Essential Plan. Build relationships with providers, community organizations, and businesses; conduct presentations and in-home consultations; manage pipeline and territory sales targets; track activities and member interactions in CRM; provide member service and feedback to internal teams.

Field-based sales and outreach role to prospect, enroll, and service eligible members in the Essential Plan. Build relationships with providers and community organizations, manage pipeline, conduct presentations and in-home consultations, track leads and enrollment metrics, and meet territory sales targets.

Provide 24/7 telephonic/telehealth urgent care for patients across settings. Cover per-diem weekend and holiday shifts, triage and direct care, document in electronic medical records, obtain necessary collaborative practice agreements and licensure, and coordinate care with facility staff and caregivers.

Provide field-based case management and care coordination for Medicaid adults: engage enrollees, link to community services, arrange aftercare appointments, perform follow-up outreach, liaise with providers, and document care plans.

The Senior Director of Benefit Innovation leads the enhancement and optimization of health plan designs, overseeing performance strategy, financial adjustments, and collaboration with sales and product leaders for new offerings.

Provide enterprise imaging consulting and hands-on administration for Change Healthcare PACS and Workflow Intelligence. Analyze radiology/cardiology workflows, diagnose and resolve PACS/software/integration issues, recommend architecture, workflow and configuration improvements, coordinate integrations with third parties, produce documentation and root-cause analyses, and support customers onsite and remotely.

Perform non-MD clinical peer reviews for outpatient mental health and substance use services across Commercial, Medicaid, and Medicare lines. Apply clinical criteria and benefit plan rules to determine coverage, review testing and treatment plans, handle appeals, document determinations, and participate in consultations and trainings. Remote for NY/NJ/CT residents.

Provide in-person member services for M&R and DSNP members in Cantonese/Mandarin: explain benefits, resolve claims and billing, fulfill material requests, translate, assist with government program applications, support quality programs and outreach, and aid Medicare sales and enrollment efforts.

The Essential Plan Account Manager drives membership growth through B2B sales, builds relationships with community partners, and manages sales activities to meet enrollment goals.

Field-based role managing provider groups to close gaps in care, collect/chart data, educate providers on Medicare quality programs, ICD-10/CPT II coding and documentation, and improve HEDIS/Stars performance. Requires frequent travel within a local territory, relationship building, data entry/analysis, and adherence to HIPAA and network requirements.

Per Diem (PRN) community pharmacist dispenses medications, counsels patients, provides medication information, ensures state pharmacy law compliance, administers immunizations, and performs standard pharmacy duties while floating between local clinic pharmacies.

Provide non‑prescribing, in‑home annual assessments for Medicare Advantage and other members, including history, med reconciliation, vitals, exams, screenings, and point‑of‑care testing. Identify diagnoses and care gaps, communicate with PCPs, educate members, address social determinants, make referrals, and recognize/respond to urgent situations.

Develop and manage provider networks by negotiating contracts, managing unit cost budgets and financial models, ensuring network adequacy, maintaining contracts, implementing regulatory changes, and resolving contract administration issues with providers and internal stakeholders.

Manage and grow a book of large strategic pharmacy accounts; lead pharmacy strategy, retention, profitability, renewals, negotiations and implementations; coordinate internal resources, engage brokers/consultants, and drive client satisfaction and financial performance.

Supervise non-clinical clinic staff, manage staffing and productivity, administer HR processes, ensure contract and quality performance, oversee inventory, scheduling, reporting, and vendor/customer relations, and serve as escalation point for technical and operational issues.

Serve as the primary relationship leader for a strategic OptumRx client, driving account retention and growth through multi-year strategy, executive engagement, cross-functional coordination, contract compliance, financial oversight, and delivery of clinical and digital innovations to improve member experience and pharmacy outcomes.

Serve as primary relationship leader for a book of strategic PBM clients: develop multi-year account strategies, drive retention and growth, lead executive engagement, coordinate cross-functional teams, ensure contract compliance, and improve financial and clinical performance.