Care Operations Manager in United States Embassy at Jobgether
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Job Description
This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Care Operations Manager based in United States.
This role offers the opportunity to build and scale critical care operations within a fast-growing healthcare environment focused on improving access, affordability, and patient outcomes.
You will take ownership of operational excellence by designing workflows, establishing performance metrics, and creating scalable processes that support high-quality care delivery.
The position combines hands-on case management, team leadership, vendor coordination, and process optimization to strengthen the patient experience.
You will collaborate closely with internal teams and external healthcare partners to improve efficiency, accountability, and operational visibility.
This is an ideal opportunity for an operations leader who thrives in high-growth environments and enjoys building systems from the ground up.
The successful candidate will help shape the foundation of a growing care operations function while making a measurable impact on patients and healthcare partners.
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.
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.
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.