Accountabilities:

As the Care Operations Manager, you will lead the development, execution, and continuous improvement of care operations processes while building a high-performing team. Your responsibilities will include:

• Hiring, training, mentoring, and managing Care Operations Associates while establishing clear performance expectations and feedback processes.
• Serving as a hands-on player-coach by managing complex escalations, including prior authorization denials, missing documentation, and provider-related challenges.
• Developing team structures and operational models that support scalability across areas such as orders, prior authorizations, and staffing requests.
• Building and implementing SLAs, KPIs, and performance tracking processes across eligibility verification, prior authorization, documentation, and partner coordination.
• Creating quality assurance processes to ensure workflows remain accurate, compliant, and effective as case volumes increase.
• Designing and improving operational workflows from the ground up while using data and case-level insights to drive coaching and performance improvements.
• Managing relationships with specialty pharmacies, nursing partners, and staffing vendors while ensuring service-level commitments are met.
• Establishing communication standards and escalation processes across healthcare partners and internal teams.
• Partnering with engineering teams to identify automation opportunities and improve operational workflows.
• Collaborating with data teams to create dashboards tracking funnel velocity, time-in-stage, throughput, and operational performance.
• Working closely with intake teams to optimize member activation processes and ensure smooth coordination across care operations.

Requirements:

The ideal candidate will bring healthcare operations expertise, strong leadership capabilities, and experience building scalable processes in complex care environments. Required qualifications include:

• 4–8+ years of experience in specialty pharmacy, payer, provider operations, or related healthcare operations environments.
• Hands-on experience across multiple areas including eligibility verification, prior authorization, insurance coordination, document collection, and provider relations.
• Direct experience managing prior authorization denials and appeals, including hands-on case resolution.
• Proven ability to build and manage SLAs and KPIs for operational teams and use performance metrics to improve outcomes.
• Experience managing external healthcare vendor relationships, including specialty pharmacies, nursing agencies, and staffing partners.
• Demonstrated success leading teams through launches, rapid growth periods, or operational scaling initiatives.
• Experience creating, improving, and implementing workflows from inception.
• Ability to maintain audit-ready documentation and compliance standards related to protected health information (PHI), consent processes, and healthcare records.
• Strong organizational, analytical, and problem-solving skills with the ability to manage competing priorities.
• Excellent communication skills and the ability to collaborate effectively with clinical, operational, technical, and external stakeholders.
• Preferred experience includes specialty pharmacy, home infusion, employer-sponsored healthcare plans, or healthcare startup environments.
• Active clinical license such as RN, PharmD, or LPN is a plus.
• Experience coordinating multi-state nursing operations is preferred.

Benefits:

The role offers the opportunity to join a mission-driven healthcare organization with benefits designed to support professional growth and employee well-being, including:

• Opportunity to help build and scale a critical healthcare operations function from an early stage.
• High-impact role with direct influence on patient experience, operational performance, and healthcare affordability.
• Collaborative environment working with healthcare, technology, and operations teams.
• Growth opportunities within a rapidly expanding organization.
• Ability to contribute to innovative solutions transforming specialty care delivery.
• Supportive workplace culture focused on inclusion, ownership, and meaningful impact.