职位描述

About the Role

This opportunity is offered on behalf of a partner organization seeking a Care Operations Manager based in the United States. The role centers on establishing and expanding vital care operations within a swiftly evolving healthcare environment focused on increasing access, cost-effectiveness, and improving patient outcomes.

Key Responsibilities

Lead hiring, training, and supervision of Care Operations Associates, setting clear performance goals and delivering regular feedback.
Act as a hands-on leader resolving complex issues such as prior authorization denials, missing documentation, and provider-related challenges.
Develop scalable team structures and operational models supporting areas like order processing, prior authorizations, and staffing requests.
Design and enforce service level agreements (SLAs), key performance indicators (KPIs), and tracking mechanisms across eligibility verification, prior authorization, documentation, and partner liaison.
Implement quality assurance procedures to maintain accuracy, compliance, and effectiveness as case volumes grow.
Create and optimize operational workflows, leveraging data and case insights to enhance coaching and team performance.
Manage partnerships with specialty pharmacies, nursing collaborators, and staffing vendors, ensuring adherence to service commitments.
Establish standards for communication and escalation pathways between healthcare partners and internal teams.
Collaborate with engineering teams to identify automation possibilities and refine workflows.
Work with data analysts to build dashboards monitoring key operational metrics, including funnel velocity and throughput.
Coordinate closely with intake teams to streamline member activation and smooth cooperation across care operations.

Candidate Requirements

4 to 8+ years of experience in specialty pharmacy, payer, provider operations, or related healthcare operations roles.
Practical expertise across multiple operational areas such as eligibility verification, prior authorizations, insurance coordination, documentation gathering, and provider relations.
Direct involvement in managing prior authorization denials and appeals, with hands-on case resolution skills.
Proven ability to establish, manage, and optimize SLAs and KPIs, using performance data to enhance outcomes.
Experience overseeing relationships with healthcare vendors including specialty pharmacies, nursing agencies, and staffing partners.
Demonstrated success in leading teams through new launches, rapid expansion phases, or scaling initiatives.
Strong background in creating and improving operational workflows from inception.
Ability to maintain documentation compliant with audit standards, protecting health information and consent protocols.
Excellent organizational, analytical, and problem-solving capabilities with aptitude for prioritizing competing demands.
Effective communication and collaboration skills with clinical, operational, technical, and external stakeholders.
Preferred qualifications include experience in specialty pharmacy, home infusion, employer-sponsored healthcare plans, or startups in healthcare.
Holding an active clinical license such as RN, PharmD, or LPN is a plus.
Experience coordinating nursing operations across multiple states is also advantageous.

Benefits and Opportunities

Chance to contribute to building and scaling an essential healthcare operations function at an early stage.
High-impact position directly influencing patient experiences, operational efficiency, and healthcare affordability.
Collaborative work environment spanning healthcare, technology, and operations disciplines.
Professional growth opportunities within a rapidly expanding organization.
Ability to innovate and transform specialty care delivery.
A supportive culture prioritizing inclusion, ownership, and meaningful impact.

Additional Information

Applications are managed by the partner company using an AI-assisted process designed to match candidates objectively and fairly based on core role competencies. The partner company controls subsequent interviews and selection steps. Applicants' personal data is processed following relevant data protection laws, including GDPR. AI tools aid the recruitment process but do not replace human decisions. For further details on data handling, contact the employer directly.

Care Operations Manager