M&R Policy Creation Manager

About the role

This position sits within the Reimbursement Policy team and is focused on shaping, maintaining, and improving reimbursement policies. The role is for an individual contributor who will support UnitedHealthcare policy development, research external sources to keep policies aligned, coordinate coding and edit changes, and help identify reimbursement opportunities.

Optum is a global health services organization that uses technology, data, pharmacy benefits, and care resources to help people live healthier lives. The company emphasizes inclusion, career growth, and benefits while working to improve health outcomes and advance health equity.

For candidates living and working in the Republic of Ireland, the role offers a flexible working arrangement where monthly hours may be divided between the Dublin or Letterkenny office and working from a home office in a hybrid setup.

Primary responsibilities

• Work with other reimbursement policy managers to support UHC policies and make sure coding and edit updates are rolled out accurately and on time.
• Move reimbursement policy work through multiple stages, including drafting documentation, creating presentations for large audiences, and preparing business requirement documents.
• Review, interpret, and work with large data sets to support policy decisions.
• Provide reimbursement and coding guidance to internal UHC teams.
• Ensure claims are processed correctly in line with reimbursement policy standards.
• Study third-party publications and reference materials related to reimbursement and coding practices.
• Act as a representative for reimbursement policy work and offer subject matter expertise on related initiatives.
• Develop and maintain department-owned materials and resources.
• Collaborate effectively across multiple functions and teams.
• Support affordability initiatives that affect several business segments.
• Bring forward practical and innovative ways of improving processes and policy work.

Required qualifications

• High school diploma or GED.
• Current CPC certification.
• Hands-on experience with CMS methodology, research, and reimbursement work.
• Experience using CES, ARU, and SAM editing tools to support payment policy.
• Working knowledge of claims platforms such as Cosmos, CSP, and/or NICE.
• Intermediate skill in Microsoft Excel and Word, including pivot tables, data files, basic formulas, subtotals, data cleanup, document review with tracked changes, adding comments, and handling heavily formatted documents with embedded tables.

Preferred qualifications

• Bachelor’s degree or above.
• Background in project management.
• Knowledge of Fraud, Waste, and Abuse recovery concepts.
• Understanding of professional and facility claim reimbursement.
• Experience preparing business requirements.
• Comfort using OneNote and PowerPoint.
• Experience creating or maintaining CES edits for reimbursement support.
• Ability to manage several projects and affordability initiatives at the same time.
• Experience reading financial reports and working with data.
• Experience writing reimbursement policies.

Soft skills

• Strong ability to prioritize and oversee several concurrent projects and affordability initiatives.
• Clear business writing skills for leadership-level summaries.
• Ability to work closely with Payment Integrity leadership and cross-functional partners.
• Strong verbal and written communication skills with the ability to present information clearly and concisely.

Eligibility

Applicants must currently be eligible to work and remain indefinitely in the country of application without any restrictions. Proof of eligibility will be required during the application process.

Additional information

Optum and UnitedHealth Group are committed to diversity, inclusion, health equity, and equal employment opportunity. The workplace is described as drug-free. The organization also notes its mission to improve health outcomes and reduce disparities affecting marginalized communities. Reference tag: #BBMEMEA.