AffirmedRx, a Public Benefit Corporation

Data Engineer

• Manage File Transfer and Security:
• Design and maintain secure client data gateways using SFTP
• Administer SharePoint file security and permissions to ensure HIPAA compliance
• Ensure complete data isolation for sensitive client information
• Infrastructure Automation and Data Workflows:
• Build and operationalize scripts using Python and PowerShell to automate file movements
• Implement proactive pipeline monitoring and automated data cleanup processes
• Develop automated notifications and workflows using Microsoft Power Platform (Power Apps, Power Automate)
• Modern Data Stack (ETL/ELT) and Data Transformation:
• Map incoming data formats CSV, Flat Files, DB files, EDI 834 Enrollment or EDI 835/837 claims files into the Data Warehouse
• Develop and optimize dbt models to transform raw claims and eligibility data
• Prepare analytics-ready tables to support business intelligence and reporting needs
• Data Troubleshooting:
• Perform root-cause analysis on complex data sets
• Identify and resolve logic errors within Accumulators, Pharmacy Claims, and Eligibility files
• Ensure data integrity across multiple pipelines and formats
• Professional Communication:
• Provide clear, concise technical guidance to internal teams
• Translate technical database errors into actionable solutions for non-technical stakeholders
• Maintain consistent communication to support cross-functional collaboration

Senior Data Operations Engineer

Manager

• The Quality Manager oversees and implements quality management programs to ensure compliance and high standards across healthcare operations
• This role leads quality improvement initiatives to enhance patient care, streamline processes, and support overall organizational goals
• The Quality Manager analyzes and interprets data to identify trends, uncover opportunities, and drive measurable improvements across healthcare and pharmacy benefit management services
• This position monitors and updates policies and procedures to ensure alignment with regulatory requirements and industry best practices
• The Quality Manager collaborates with cross-functional teams to address challenges, develop solutions, and implement effective, sustainable process improvements.

Quality Manager

Director

• Define and evolve the organization’s utilization management strategy, ensuring alignment with client benefit designs, affordability goals, regulatory requirements, and AffirmedRx’s transparent PBM model
• Serve as a clinical and operational thought partner to executive leadership, advising on UM tradeoffs related to access, member experience, cost management, and regulatory risk
• Translate client-specific goals and contractual requirements into tailored UM programs, guardrails, and workflows
• Develop a multi-year UM roadmap, including technology enablement, automation, and electronic PA integration
• Own end-to-end PA and UM operations, including intake, clinical review, peer-to-peer processes, determinations, and communications
• Establish and monitor operational KPIs (turnaround times, quality accuracy, production metrics, escalation rates) and drive corrective actions
• Optimize UM workflows to ensure scalability, audit readiness, and seamless integration with client and provider systems
• Lead process improvement initiatives leveraging data, root cause analysis, and automation
• Ensure UM decisions are evidence-based, clinically sound, and aligned with plan design and coverage criteria
• Oversee peer-to-peer review processes and ensure consistent, high-quality clinical determinations
• Review and assess clinical literature to support UM criteria, policy updates, and provide guidance
• Ensure accuracy and consistency of denial rationales, clinical communications, and member/provider-facing materials
• Partner with finance and clinical strategy teams to assess the financial impact of UM programs, including cost avoidance, utilization trends, and operational efficiency
• Ensure UM strategies balance affordability with access, minimizing inappropriate utilization while avoiding unnecessary member or provider friction
• Support budgeting, forecasting, and resource planning for UM operations
• Serve as an escalation point for complex or high-impact client UM issues, delivering timely, thoughtful, and defensible resolutions
• Support client-facing discussions related to UM strategy, program performance, and regulatory compliance
• Partner with Client Success and Sales teams to support implementations, renewals, and ongoing client satisfaction
• Ensure ongoing compliance with URAC, NCQA, and applicable regulatory requirements
• Maintain audit readiness and lead UM-related accreditation activities, assessments, and corrective action plans
• Stay current on evolving UM regulations, industry standards, and best practices, proactively adjusting programs as needed

Director, Utilization Management

• Define and drive the product vision, strategy, and multi-year roadmap for assigned clinical and pharmacy programs
• Serve as the end-to-end Product Owner, accountable for product lifecycle management from ideation through optimization
• Ensure products remain market-relevant, competitive, and aligned with organizational growth objectives
• Support sales and marketing efforts
• Monitor market for competitive trends
• Lead cross-functional program planning and execution to ensure on-time, high-quality product delivery
• Establish clear milestones, success metrics, and governance processes to drive disciplined execution
• Identify risks, remove barriers, and ensure seamless integration across systems and workflows
• Partner with Operations, IT, Implementation, Sales, Client Success, Pricing, and external partners to align priorities and deliver outcomes
• Translate strategic objectives into actionable plans across departments
• Serve as the central point of accountability and decision-making for assigned products and programs
• Monitor product performance, financial impact, and client outcomes to inform enhancements
• Drive continuous improvement initiatives to improve scalability, efficiency, and user experience
• Incorporate stakeholder and market feedback into ongoing product refinement and innovation

Senior Data Operations Engineer

Quality Manager

Director, Utilization Management

Director, PBM Product Strategy – Delivery