PBM Operations & Implementations Manager

New York

ABOUT RIGHTWAY

Rightway Healthcare was founded in early 2017 by a team of dedicated healthcare, business and technology leaders. Rightway is a technology platform that provides employees and their families with the support, information and advocacy they need to be better healthcare consumers. We combine a high-tech consumer portal with a high-touch dedicated concierge environment to provide consumers with the same level of support and guidance they would receive if they had a doctor in the family. We are focused on personalization, implementation, advocacy and results.

Rightway works with employers from 100 – 25,000 employees to provide an ecosystem of healthcare navigation for employees. We are committed to generating high member satisfaction scores, industry leading engagement and a quantifiable ROI for every employer. Our approach is rooted in analytics and guided by a bottom-up understanding of a population.

Rightway is privately financed, having raised over $30mm to date from investors such as Thrive Capital.

It is headquartered out of New York City, with new offices in Hudson Yards. We also have remote offices in Miami, FL and San Francisco, CA.

RESPONSIBILITIES

  • Support implementation and client management teams with all day-to-day client requirements
  • Support implementation of new plans, pricing, and networks, consistent with strategic or administrative intent
  • Lead pre- and post-implementation quality assurance and testing to validate coding accuracy
  • Responsible for timely and accurate management and execution of all client benefit requests, including benefit changes, eligibility changes, and new implementations
  • Analyze incoming client requests and work with internal and external teams to complete required plan documentation
  • Lead claim reviews to proactively identify discrepancies or inaccuracies and develop solutions to address
  • Handle and resolve sponsor and member issues, escalating as needed
  • Research and respond to claims processing and system configuration inquiries
  • Coordinate integration of other data inputs into client management processes
  • Collaborate cross functionally to support general client operations, as required

REQUIREMENTS

  • Education level: Bachelor’s degree
  • Work experience: 4 years in PBM operations or Health Plan operations
  • Location information: New York City highly preferred, or Miami
  • Important characteristics of ideal candidate: Detail-oriented, intellectually curious, good listener, ability to challenge status quo, values exemplar
  • Specific skills needed for job: Highly effective & creative problem-solver, ability to prioritize, ability to manage through change and lead through times of chaos, solid communication skills, great people leadership

Rightway Healthcare is proud to be an Equal Employment Opportunity employer. We consider applicants without regards to race, color, national origin, sex, age, religion, sexual orientation, gender identity, veteran status, marital status, physical or mental disability, or other protected classes under all local, state, and federal laws and ordinances.

PBM Operations & Implementations Manager

New York

ABOUT RIGHTWAY

Rightway Healthcare was founded in early 2017 by a team of dedicated healthcare, business and technology leaders. Rightway is a technology platform that provides employees and their families with the support, information and advocacy they need to be better healthcare consumers. We combine a high-tech consumer portal with a high-touch dedicated concierge environment to provide consumers with the same level of support and guidance they would receive if they had a doctor in the family. We are focused on personalization, implementation, advocacy and results.

Rightway works with employers from 100 – 25,000 employees to provide an ecosystem of healthcare navigation for employees. We are committed to generating high member satisfaction scores, industry leading engagement and a quantifiable ROI for every employer. Our approach is rooted in analytics and guided by a bottom-up understanding of a population.

Rightway is privately financed, having raised over $30mm to date from investors such as Thrive Capital.

It is headquartered out of New York City, with new offices in Hudson Yards. We also have remote offices in Miami, FL and San Francisco, CA.

RESPONSIBILITIES

  • Support implementation and client management teams with all day-to-day client requirements
  • Support implementation of new plans, pricing, and networks, consistent with strategic or administrative intent
  • Lead pre- and post-implementation quality assurance and testing to validate coding accuracy
  • Responsible for timely and accurate management and execution of all client benefit requests, including benefit changes, eligibility changes, and new implementations
  • Analyze incoming client requests and work with internal and external teams to complete required plan documentation
  • Lead claim reviews to proactively identify discrepancies or inaccuracies and develop solutions to address
  • Handle and resolve sponsor and member issues, escalating as needed
  • Research and respond to claims processing and system configuration inquiries
  • Coordinate integration of other data inputs into client management processes
  • Collaborate cross functionally to support general client operations, as required

REQUIREMENTS

  • Education level: Bachelor’s degree
  • Work experience: 4 years in PBM operations or Health Plan operations
  • Location information: New York City highly preferred, or Miami
  • Important characteristics of ideal candidate: Detail-oriented, intellectually curious, good listener, ability to challenge status quo, values exemplar
  • Specific skills needed for job: Highly effective & creative problem-solver, ability to prioritize, ability to manage through change and lead through times of chaos, solid communication skills, great people leadership

Rightway Healthcare is proud to be an Equal Employment Opportunity employer. We consider applicants without regards to race, color, national origin, sex, age, religion, sexual orientation, gender identity, veteran status, marital status, physical or mental disability, or other protected classes under all local, state, and federal laws and ordinances.

PBM Operations & Implementations Manager

New York

ABOUT RIGHTWAY

Rightway Healthcare was founded in early 2017 by a team of dedicated healthcare, business and technology leaders. Rightway is a technology platform that provides employees and their families with the support, information and advocacy they need to be better healthcare consumers. We combine a high-tech consumer portal with a high-touch dedicated concierge environment to provide consumers with the same level of support and guidance they would receive if they had a doctor in the family. We are focused on personalization, implementation, advocacy and results. Rightway works with employers from 100 – 25,000 employees to provide an ecosystem of healthcare navigation for employees. We are committed to generating high member satisfaction scores, industry leading engagement and a quantifiable ROI for every employer. Our approach is rooted in analytics and guided by a bottom-up understanding of a population. Rightway is privately financed, having raised over $30mm to date from investors such as Thrive Capital. It is headquartered out of New York City, with new offices in Hudson Yards. We also have remote offices in Miami, FL and San Francisco, CA.

RESPONSIBILITIES

  • Support implementation and client management teams with all day-to-day client requirements
  • Support implementation of new plans, pricing, and networks, consistent with strategic or administrative intent
  • Lead pre- and post-implementation quality assurance and testing to validate coding accuracy
  • Responsible for timely and accurate management and execution of all client benefit requests, including benefit changes, eligibility changes, and new implementations
  • Analyze incoming client requests and work with internal and external teams to complete required plan documentation
  • Lead claim reviews to proactively identify discrepancies or inaccuracies and develop solutions to address
  • Handle and resolve sponsor and member issues, escalating as needed
  • Research and respond to claims processing and system configuration inquiries
  • Coordinate integration of other data inputs into client management processes
  • Collaborate cross functionally to support general client operations, as required

REQUIREMENTS

  • Education level: Bachelor’s degree
  • Work experience: 4 years in PBM operations or Health Plan operations
  • Location information: New York City highly preferred, or Miami
  • Important characteristics of ideal candidate: Detail-oriented, intellectually curious, good listener, ability to challenge status quo, values exemplar
  • Specific skills needed for job: Highly effective & creative problem-solver, ability to prioritize, ability to manage through change and lead through times of chaos, solid communication skills, great people leadership
Rightway Healthcare is proud to be an Equal Employment Opportunity employer. We consider applicants without regards to race, color, national origin, sex, age, religion, sexual orientation, gender identity, veteran status, marital status, physical or mental disability, or other protected classes under all local, state, and federal laws and ordinances.