Director Compliance (PBM Commercial & Exchange) - Remote

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 in making healthcare work better for everyone through people-led, responsible AI while Caring. Connecting. Growing together.

The Director, Compliance leads operational compliance for the OptumRx PBM Commercial and Exchange lines of business across all 50 states by monitoring and supporting the business with the development of scalable operational controls to meet state and federal requirements, high-risk regulatory implementations, and conducting compliance monitoring. Scope includes state PBM reforms, HIX/Exchange requirements, CAA transparency obligations, proposed DOL fee-disclosure requirements, client contractual disclosure and audit provisions, and state regulator examinations and enforcement actions.

This role identifies and incorporates regulatory requirements early in business, operational, and functional design to support successful implementation processes. The Director enables compliant, scalable, and sustainable solutions; closes readiness and go-live gaps; and provides dedicated leadership for complex state implementation, HIX, federal transparency, predictive enablement, and continuing evidence readiness.

General Job Profile

• Acts as the dedicated senior compliance owner and advisor for PBM Commercial and Exchange regulatory risk, operational controls, implementation readiness, compliance monitoring, evidence sufficiency, regulator-facing escalations, and cross-functional decisions involving Legal, Regulatory Affairs, Finance, and Operations
• Provides leadership and accountability through multiple layers of management
• Impacts large business units or multiple markets/sites

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:

• Complex State Implementation and Operational Compliance
  • Oversee high-impact state reforms affecting PBM transparency, pharmacy reimbursement, affiliate parity, network access, pricing, delinking, prior authorization, and formulary requirements, and close readiness and go-live gaps
  • Lead resolution of implementation and control gaps identified through readiness reviews, testing, compliance validations, audit findings, corrective action plans, and post-go-live monitoring
  • Deliver targeted 'kitchen sink' compliance support for high risk implementations to stabilize launches and reduce regulatory and operational exposure
  • Serve as the senior compliance escalation point for go-live events, state DOI and federal regulator matters, market conduct examinations, corrective action plans, enforcement actions, and material regulatory changes affecting 50-state Commercial and Exchange operations
• PBM Preventative Enablement & Predictive Design
  • Lead business toward PBM Preventative Enablement, including enterprise risk projects and predictive design strategy efforts across their business tools that support compliance:
    • RxComet, SalesForce, Service Now
    • Client Pricing Management Tool
    • RxClient360
    • PowerBi Central Repository Expansions
  • Drive early identification and shaping of regulatory and operational requirements, partnering with Regulatory Affairs, Legal, Operations, and Implementation teams to embed compliance processes and culture
  • Reduce downstream defects, post implementation remediation, and regulatory findings through proactive design controls and requirement clarity
• Federal Transparency, HIX Implementation & State Enforcement Readiness
  • Provide compliance support for CAA and proposed DOL transparency requirement implementation, including compensation and affiliate disclosures, reporting, audit rights, contract support, and data lineage, in coordination with Legal, Regulatory Affairs, Finance, Operations, and client teams
  • Establish continuous HIX compliance support and evidence readiness under the 2027 NBPP across delegated pharmacy operations, network and provider-access data, benefit and formulary design, quality support, issue traceability, contractual flow-downs, and retention of regulator-ready evidence
  • Guide remediation and prevention strategies for DOI market conduct examinations, corrective action plans, regulator complaints, and enforcement actions; ensure root causes, ownership, milestones, validation, and executive escalations are documented
  • Provide senior oversight of plan advisory, issue management, complaints, compliance validations, and regulatory compliance across the Commercial and Exchange portfolio
• Other Specialized PBM Focus Areas
  • Provide additional subject matter compliance oversight for:
    • Prior authorization, utilization management, formulary, and HIX/Exchange benefit-design requirements
    • Network pricing and access requirements, including pharmacy reimbursement, affiliate parity, pass-through pricing, anti-steering, and network restrictions
    • Monitor evolving PBM delinking laws and ensure compliant separation of pricing, spread, and reimbursement constructs where required

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:

• 7+ years demonstrated leadership experience in PBM, health plan, pharmacy, or similarly complex health care regulatory compliance, including accountability for multi-state or federal implementation
• 3+ years demonstrated experience leading cross-functional regulatory change, complex state implementation and remediation following audit findings, corrective action plans, issue management, compliance validation, and/or regulator-facing escalations
• Working knowledge of PBM pricing, reimbursement, network, formulary, utilization management, transparency, compensation, and Exchange compliance concepts; ability to translate regulatory requirements into operational controls and defensible evidence
• Proven executive communication, people leadership, and influence skills sufficient to resolve material risk across Legal, Regulatory Affairs, Finance, Product, Operations, Network, Implementation, and client-facing teams
• Proven ability to use automation appropriately while retaining accountability for regulatory judgment, cross-functional decisions, remediation, and regulator-facing matters

*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 $134,600 - $230,800 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.