Care Operations Manager

This is a fully remote position, open to applicants in United States.

📋 Description

• Recruit, train, and oversee Care Operations Associates, implementing a management cadence and a consistent feedback mechanism.

• Personally address the most intricate, escalated cases — including denied PAs, missing documentation, and provider pushback — acting as a hands-on player-coach during the 1/1 launch.

• Reorganize the team into functional sub-segments (orders, prior authorizations, staffing requests) as the headcount approaches 10 Care Operations Associates.

• Establish and enforce SLAs and KPIs for eligibility verification, prior authorization, documentation, and coordination with partners.

• Create and implement an initial QA process to ensure workflows are robust under actual case volume before the launch.

• Develop or redesign essential workflows from the ground up, utilizing case-level metrics to guide coaching rather than just reporting.

• Manage specialty pharmacy relationships, ensuring partners are accountable for shipment scheduling and SLA commitments.

• Oversee nursing and staffing agency partnerships across various states, addressing staffing disputes and escalations.

• Define communication standards for issue reporting and relationship-building among LTNs, staffing agencies, and specialty pharmacies.

• Collaborate with Engineering to outline and develop automations for partner request workflows.

• Work alongside the Data team to create live dashboards that monitor funnel velocity, time-in-stage, and throughput.

• Coordinate with Intake Coordinators regarding consent-form volume entering member activation.

⛳️ Requirements

• 4-8+ years of experience in specialty pharmacy, payer, or provider-side operations, with hands-on involvement in at least three of the following: eligibility verification, prior authorization, insurance/payer coordination, document collection, provider relations.

• Direct experience with prior authorization denials and appeals, rather than merely overseeing others who manage them.

• Proven history of establishing or managing SLAs/KPIs for an operations team and utilizing these metrics to enhance coaching.

• Experience managing external vendor relationships on a large scale — including specialty pharmacies and nursing/staffing agencies — while ensuring partners adhere to SLAs and resolving escalations.

• Experience leading a team during a launch, volume increase, or rapid scaling event.

• Demonstrated capability to construct or significantly redesign a workflow from scratch.

• Proficiency in managing a function with audit-ready documentation and compliance standards (PHI, consent, dispense records).

🏝️ Benefits

• Offers Equity