From intake to outcomes, CareMetx is dedicated to delivering industry-leading patient access solutions and support services that help patients quickly start and stay on specialty therapy treatments. We provide scalable, efficient digital hub services for pharmaceutical companies and healthcare providers, streamlining workflows with seamless integration for patient enrollment, consent, and prior authorization. Our best-in-class patient support services enhance every step of care, connecting patients, providers, and brands to drive better outcomes and accelerate time-to-therapy.

JOB TITLE: Operations Manager (HUB)

POSITION SUMMARY:

 The Operations Manager is responsible for managing, coaching, developing, directing, and leading a high performing team of Case Managers who educate patients and their families on product access, reimbursement processes, and help with the management of therapy delivery. In addition, this role will work closely with patients, caregivers, and providers to help support a patient gain access to therapy and help ensure ongoing compliance with therapy, as appropriate. 

PRIMARY DUTIES AND RESPONSIBILITIES:

• Ensures team is meeting contractual obligations.
• Design programs and Training content which promote high motivation among team members.
• Conducts performance reviews and rewards positive behavior.
• Coaches, counsels, and sets goals for supervisors to help develop them for career progression.
• Provides day-to-day instructions to team members on job responsibilities.
• Helps associates resolve associate work-related issues.
• Supports new associates in their efforts for growth and development.
• Participates in the hiring and termination process.
• Develops designs and conducts Train the Trainer program.
• Provides feedback up and down the organization (Positive and Constructive).
• Participates in client meetings; prepares agenda and / or takes meeting notes.
• Ensures open communication with program support.
• Translates and oversees organizational strategies for assigned goals.
• Identifies client issues; receives and triages client requests.
• Proactively identifies program issues and proposes ways in which to address their concerns.
• Maintains positive rapport with client
• Understands the billing process and contractual obligations.
• Participates in budget planning.
• Accountable and responsible for program quality and compliance with standard operating procedures.
• Designs project task plan and standard operating procedures.
• Develops and maintains program SOPs, Work instructions and Job Aids
• Analyzes reports for trends and gives recommendations.
• Analyzes progress of tactical issues.
• Reports all Adverse Events (AE) disclosed in alignment with training and Standard Operational Procedures (SOP)
• Maintain regular and reliable attendance, including being present, on time, and prepared for work as scheduled.
• Performs other related duties as assigned.

EXPERIENCE AND EDUCATIONAL REQUIREMENTS:

• Minimum 5 + years' experience in the pharmaceutical/healthcare industry  
• Minimum  4+ years reimbursement management experience ( reimbursement hub, specialty pharmacy, physician’s office, medical insurance, healthcare setting, and/or related experience).  
• Minimum 3+ years direct people management experience.  
• Minimum 2 + years cell/gene therapy
• Minimum 2 + years experience/exposure to pediatric patients & CareGivers.
• Bachelor’s Degree (general business, health sciences, public policy, or other related degrees) preferred 
• Licensed Social worker, Patient Advocacy or equivalent experience preferred
• Ability to travel (overnight) up to 20% of the time within all territories (East, Central, Mountain, Pacific)
• Schedule flexibility to be able to provide backup coverage for program operations and covering Case Manager responsibilities in the event of planned/unplanned absences.

MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS:

• Strong interpersonal skills and attention to detail.
• Ability to communicate effectively both orally and in writing.
• The ability to manage multiple tasks.
• Working knowledge of Microsoft Office.
• Ability to resolve associate issues effectively and efficiently.
• General knowledge of reimbursement, patient assistance programs, database elements and functionality; operational policies and processes particularly distribution processes / interfaces.
• Proven ability to appropriately escalate issue to management.
• Health care research and analysis skills sufficient to support payer research, healthcare policy library and state management.
• Demonstrated player/ coach mindset  with a willingness to answer calls, work cases and rotate the late shift coverage
•  Demonstrated ability to be a primary client contact 
• Ability to set program goals and work independently

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to sit
• The employee must occasionally lift and/or move up to 10 pounds.

WORK ENVIRONMENT:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.   

SCHEDULE:

• Program Hours of Operation are 8am - 8pm eastern
• Must be flexible on schedule and hours
• Moderate travel is required (up to 20% travel)  

CareMetx considers equivalent combinations of experience and education for most jobs. All candidates who believe they possess equivalent experience and education are encouraged to apply.

At CareMetx we work hard, we believe in what we do, and we want to be a company that does right by our employees. Our niche industry is an integral player in getting specialty products and devices to the patients who need them by managing reimbursements for those products, identifying alternative funding when insurers do not pay, and providing clinical services.

CareMetx is an equal employment opportunity employer. All qualified applicants will receive consideration for employment and will not be discriminated against based on race, color, sex, sexual orientation, gender identity, religion, disability, age, genetic information, veteran status, ancestry, or national or ethnic origin.

Artificial Intelligence in Our Recruiting and Employment Process

CareMetx uses artificial intelligence and automated decision-making technology to support parts of our recruiting, hiring, and employment process, including screening applications, scheduling interviews, and evaluating candidate qualifications. These tools support, not replace, human judgment. A qualified member of our team reviews and makes all final hiring and employment decisions.

CareMetx does not develop or use AI tools with the intent to discriminate against applicants or employees on the basis of race, color, religion, sex, age, sexual orientation, national origin, disability, veteran status, or any other protected characteristic.