Care Operations Manager

1 мес. назад

80k–110k USD / yearUSAMiddleRemote

sla managementkpIsquality assurancevendor management

Builds operational processes, SLAs, KPIs for Care Operations, manages team rigor and vendor performance in specialty pharmacy benefits.

Обязанности

is scaling its Care Operations and this role exists to build the SLAs, KPIs, and workflows that don't yet exist for eligibility, prior authorization, documentation, and partner coordination. The Care Operations Manager owns the team's operational rigor, setting a management cadence, standing up QA processes, and building the tracking that shows funnel velocity and throughput. This person works closely with Intake Coordinators, Engineering, and the Data team, and partners directly with specialty pharmacies and staffing agencies to hold external vendors to SLA. Reporting to the Head of Member Operations and Strategy, they'll start as a hands-on player-coach on the highest-stakes cases and shift over the first year into a manager leading a growing team of Care Operations Associates throu

Будет плюсом

Specialty pharmacy or home infusion-specific experience
Experience with self-insured employers or employer-sponsored plans
Active clinical license (RN, PharmD, LPN)
Multi-state nursing agency coordination experience
Healthcare startup or fast-scaling care-delivery background
At , we’re building an outlier company with real impact — and that takes focus, energy, and commitment. If that excites you, we’d love to hear from you. is an equal opportunity employer and welcomes applicants from all backgrounds. We’re committed to building a team that reflects a diversity of perspectives, experiences, and identities.

Другое

is one of the fastest-growing benefits solutions and a category-defining pioneer in employer specialty pharmacy. We are reshaping how life-changing therapies are delivered and financed, ensuring patients get the treatment they need while employers finally get a fair deal.
Specialty drugs and infusions represent nearly 10% of all healthcare spend and are the fastest-growing cost category for employers. tackles this challenge with a novel approach: eliminating hidden markups, expanding access to high-quality infusion providers, and bringing clarity and fairness to how therapies are priced and paid for.
We’re proud to partner with numerous Fortune 500 companies and leading TPAs. Each patient we serve creates immediate ROI: lower costs, improved access, and better care. Join us as we redefine what’s possible in specialty care.
Hire, train, and manage Care Operations Associates, establishing a management cadence and consistent feedback loop
Personally handle the most complex, escalated cases — denied PAs, missing documentation, provider pushback — as a hands-on player-coach through the 1/1 launch
Restructure the team into functional sub-segments (orders, prior authorizations, staffing requests) as headcount scales toward 10 Care Operations Associates
Build and enforce SLAs and KPIs across eligibility verification, prior authorization, documentation, and partner coordination
Design and run an initial QA process to validate that workflows hold up under real case volume ahead of launch
Build or redesign core workflows from scratch, and use case-level metrics to drive coaching rather than pure reporting
Own specialty pharmacy relationships, holding partners accountable to shipment scheduling and SLA commitments
Manage nursing and staffing agency partnerships across multiple states, resolving staffing conflicts and escalations
Set communication standards for issue reporting and rapport-building across LTNs, staffing agencies, and specialty pharmacies
Partner with Engineering to scope and build automations for partner request workflows
Work with the Data team to build live dashboards tracking funnel velocity, time-in-stage, and throughput
Coordinate with Intake Coordinators on consent-form volume flowing into member activation
4-8+ years in specialty pharmacy, payer, or provider-side operations, with hands-on experience across at least 3 of: eligibility verification, prior authorization, insurance/payer coordination, document collection, provider relations
Direct experience personally working prior authorization denials and appeals, not just overseeing others who do
Track record of building or running SLAs/KPIs for an operations team and using those metrics to drive coaching
Experience managing external vendor relationships at scale — specialty pharmacies, nursing/staffing agencies — including holding partners to SLAs and resolving escalations
Experience managing a team through a launch, volume surge, or rapid scale event
Demonstrated ability to build or meaningfully redesign a workflow from the ground up
Comfort owning a function with audit-ready documentation and compliance standards (PHI, consent, dispense records)