At Rightway we are committed to creating a diverse environment and are proud to be an equal opportunity employer. We hire for the best talent and actively seek diversity of thought processes, beliefs, background and education. Rightway fosters an inclusive culture where differences are celebrated to drive the best business decisions possible.
We are committed to equal opportunity and fairness regardless of race, color, religion, sex, gender identity, sexual orientation, nation of origin, ancestry, age, physical or mental disability, country of citizenship, medical condition, marital or domestic partner status, family status, family care status, military or veteran status or any other basis protected by local, state or federal laws.
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 $130mm 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.
ABOUT THE ROLE
Team Description: The Enrollment & Eligibility Operations Manager is a member of the RightwayRx Operations team reporting to the Sr Director of PBM Operations. This role works regularly with members of the technology and data teams, as well as third party vendors and TPAs, health plans and other external stakeholders to manage daily operations of eligibility and related functions, including claim accumulator processes.
Role Description: Our pharmacy benefit management (PBM) offering represents an important growth area for Rightway. Helping clients better manage pharmacy spend to make drugs more affordable for their employees and dependents is critical to their business sustainability. RightwayRx is responsible for designing, building and operating a new-to-the-world PBM model base on our core tenets: fairness & transparency, unlocking the supply chain, supporting the physician-patient relationship, and utilizing navigation to empower consumers
- Partner to develop, establish and deploy enrollment and eligibility strategies that are aligned with company goals and focused on customer and consumer experience.
- Serve as business lead to direct and manage implementation projects related to eligibility functions. Leverage latest industry trends and technologies when deploying solutions.
- Collaborates with technology, account management, benefit administration, and other internal stakeholders to ensure that eligibility functions are implemented and operating in accordance with requirements.
- Identify, recommend and oversee system modifications and enhancements that will increase efficiency in process and use of systems.
- Work with external vendors and client partnerships to define business requirements, oversee integration efforts and perform testing.
- Manage the execution of all eligibility and accumulator operations and interfaces from implementation through ongoing operations and maintenance.
- Manages all downstream vendor feeds (i.e. ID card fulfillment), third party integrations (i.e. health plans, TPAs) and ensures all deliverables are met timely and troubleshoots issues.
- Serve as an escalation contact for internal and external partners.
- Perform other duties and projects as assigned.
- Education level: Bachelors Degree Required. Preferred: Masters Degree
- Work experience: +5 years of relevant work experience
- Location information: NYC or Denver. Highly qualified remote candidates will be considered (occasional travel may be required)
- Important characteristics of ideal candidate: Detail-oriented, analytical, intellectually and clinically curious, good listener, empathetic, ability to challenge status quo, values exemplar
- Specific skills needed for job: Prior experience working with health plan, TPA, or PBM eligibility operations, effective & creative problem-solver, ability to prioritize and manage through change. Solid communication skills, ability to lead projects and influence others even without direct reporting line ownership
- Competitive Compensation
- Full Benefits (Medical, Dental, Vision, Commuter)
- 401K plan
- Company sponsored social events
Rightway is proud to be an Equal Employment Opportunity employer
We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics