Care Operations Manager
$80,000–$110,000 year
RemoteUnited States
Job Summary
Build SLAs, KPIs, and workflows for eligibility verification, prior authorization, documentation, and partner coordination. Hire, train, and manage Care Operations Associates while personally handling complex escalated cases like denied PAs and missing documentation. Restructure the team into functional sub-segments and enforce QA processes to validate workflows under real case volume. Own specialty pharmacy relationships and manage nursing/staffing agency partnerships across multiple states, holding vendors accountable to shipment scheduling and SLA commitments. Partner with Engineering to scope automations and work with the Data team to build live dashboards tracking funnel velocity and throughput. Coordinate with Intake Coordinators on consent-form volume flowing into member activation. This role starts as a hands-on player-coach through the 1/1 launch, shifting to leading a growing team as headcount scales toward 10 associates.
Required Qualifications
- 4-8+ years in specialty pharmacy, payer, or provider-side operations
- 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
- Track record of building or running SLAs/KPIs for an operations team
- Experience managing external vendor relationships at scale
- 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)
Desired Qualifications
- 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
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