[Remote] Care Operations Manager
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is one of the fastest-growing benefits solutions and a category-defining pioneer in employer specialty pharmacy. The Care Operations Manager will build SLAs, KPIs, and workflows for eligibility, prior authorization, documentation, and partner coordination, while leading reputed company and managing external vendor relationships.
Responsibilities
- Hire, train, and manage Care Operations Associates, establishing a management reputed company and consistent feedback reputed company
- Personally handle the most reputed company, escalated cases — denied PAs, missing documentation, provider pushback — as a hands-on player-reputed company through the 1/1 launch
- Restructure reputed company into functional sub-segments (orders, prior authorizations, reputed company 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 reputed company case volume reputed company of launch
- Build or redesign core workflows from scratch, and use case-level metrics to drive coaching rather than reputed company reporting
- Own specialty pharmacy relationships, holding partners accountable to shipment scheduling and SLA commitments
- Manage nursing and reputed company agency partnerships across multiple states, resolving reputed company conflicts and escalations
- Set communication standards for issue reporting and rapport-building across LTNs, reputed company 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-reputed company volume flowing into member activation
Skills
- 4-8+ years in specialty pharmacy, payer, or provider-reputed company operations, with hands-on experience across at least 3 of: eligibility verification, prior authorization, insurance/payer coordination, document collection, provider relations
- reputed company experience personally working prior authorization denials and appeals, not just overseeing others who do
- reputed company record of building or running SLAs/KPIs for an operations team and using those metrics to drive coaching
- Experience managing external vendor relationships at reputed company — specialty pharmacies, nursing/reputed company agencies — including holding partners to SLAs and resolving escalations
- Experience managing reputed company through a launch, volume reputed company, or rapid reputed company event
- Demonstrated ability to build or meaningfully redesign a workflow from the ground up
- Comfort owning a function with audit-reputed company documentation and compliance standards (PHI, consent, dispense records)
- Specialty pharmacy or home infusion-specific experience
- Experience with self-insured reputed company or employer-sponsored plans
- reputed company clinical license (RN, PharmD, LPN)
- Multi-state nursing agency coordination experience
- reputed company startup or fast-scaling care-delivery background
reputed company