CareMetx, LLC

Compliance

• Manage the day-to-day operation of CareMetx’s governance, risk, and compliance program.
• Ensure all HIPAA, SOC 2, and NIST CSF 2.0 controls in the GRC platform maintain current evidence.
• Run the IT Risk Management process, managing external audits and customer security reviews.
• Support policy and continuity-testing programs, keeping CareMetx continuously audit-ready.

Governance, Risk, and Compliance Analyst

Product Operations

• Serve as accountable party for tracking and driving all productization workstreams required for product launches (new products, major features, or capability releases) across internal hub, pharmacy, and external hub product lines. • Define and maintain pre-launch checklists for product releases, ensuring all cross-functional deliverables (operations, technology, compliance, marketing, documentation) are complete and approved prior to a product's go-to-market date. • Partner with Product and Operations teams to plan and sequence product launch activities, milestones, and dependencies — prior to initiating internal and external communication. • Proactively identify and escalate risks, blockers, and gaps in product launch readiness; facilitate resolution with appropriate stakeholders. • Participate in Quarterly Product Business Reviews, providing updates on product launch readiness, product operations status, and key initiatives. • Coordinate with the marketing team on collateral, messaging, and campaign execution related to product launches and updates. • Provide input on external-facing product documentation such as client-facing materials, provider guides, and patient support resources, in coordination with PMs and Product Owners.

Senior Product Operations Manager

Manager

• Under the general direction of the designated manager, the Patient Services Senior Manager is responsible for the successful delivery of all contracted services of respective Patient Services programs.
• Provide program operational oversight, administration and management of one or more operational programs.
• Lead an operational team of managers and associates by establishing goals and expectations for team oversight, setting direction and influencing team performance through the development and coaching of managers.
• Ensure the program is operating in accordance to client service levels, compliance standards and operational efficiency.
• Work with the client to provide program updates, regular reporting, and address client issues.
• Collaborate with the Director and New Business Development on new business initiatives as well as in offering creative solutions to expand service offerings to clients.
• Serve as the primary liaison between company and client as it relates to program operations; lead client operational meetings; field client questions and requests; interpret client needs and develop appropriate action plan; work with management team to monitor, assess and identify strategies to improve program processes, services, systems and analysis; engage with appropriate client contacts to provide proactive updates, address concerns and explore program opportunities and provide internal advocacy for client.
• Work with management team to ensure that team is meeting contractual obligations and to seek ways to improve operational performance; identify staffing needs and work with HR to recruit appropriate staffing; serve as the interface for cross functional activities; work with team management to design programs to maintain high motivation among team members; manage overall program performance including pending work and proactively manage bottlenecks by shifting resources; responsible for establishing and monitoring goals for the team; ensure Managers are effectively managing individual productivity, quality and compliance; conduct performance reviews and quarterly talent reviews of management team; provide training and mentoring to team members and conduct career development discussions; hold regular meetings with team and one-on-one meetings with managers; provide coaching and guidance to leaders and partner with Human Resources in the resolution of associate relations issues.
• Translate organizational strategies into team goals; lead training sessions; mentor managers; develop plans to facilitate growth and development for team members; help identify potential opportunities for team members; conduct quarterly talent review, coach and counsel managers and assistant managers and help prepare them for next level.
• Work in coordination with Director to include managing monthly budget and expenses; complete follow-up on outstanding invoices; may participate in budget development; apply key financial indicators (i.e., operating income, revenue, ROCC, and Flash) to help measure program financial performance.
• Explain to clients how we ensure and track quality; manage quality trending; implement and ensure that processes are in place to monitor quality and program compliance; collaborate with Compliance team on program audits; ensure ongoing program compliance to policies and procedures; work with leadership team to address audit findings and to implement corrective action.
• Support company initiatives; exemplify core values; accept and effectively communicate decisions on company policies, plans and programs; ensure open communication at all levels; and reward appropriate behavior.
• May collaborate across various groups (i.e. IT, PMO, NBD) on program projects, new service line implementations, database updates, UAT. May require travel to attend client meetings, training, or to support team members across multiple offices.
• Performs related duties as assigned.

Senior Manager, Patient Services

Director

• Provides senior leadership on multiple client accounts or practice areas.
• Responsible for strategic management.
• Creates mission and works with management team to ensure a clear understanding of team mission and goals.
• Works with management team to help identify skills that are needed for projects or work activities and match skill requirements with talent.
• Develops performance standards for management team and measures success against performance standards.
• Creates innovative business expansion and/or new services.
• Responsible for lead proposal writing, contracting, client presentations, and pricing.
• Establishes goals for business unit growth.
• Stays abreast of industry trends and important pending legislation impacting business.
• May maintain specialized technical skills in a disease state, hold expert medical knowledge on reimbursement strategies, and/or possesses functional knowledge.
• Identifies and collaborates with internal and external resources and experts.
• Develops succession plans for key management team members.
• Recruits, trains and develops senior leaders.
• Provides leadership to team and participates as facilitator for learning programs.
• Manages budget to include P&L responsibility.
• Approves purchases, contracting, expenses, and may manage vendor relationships.
• Allocates human and financial resources as appropriate to ensure objectives are accomplished.
• Searches and pursues revenue generation opportunities and effectively manages to ensure that new revenue is realized.
• Trains managers on financial matters related to performing job responsibilities.
• Overall responsibility for timeliness, accuracy, and completeness of all services.
• Identifies areas for risk; fosters proactive, continued quality improvement.
• Ensures and maintains highest integrity and honesty in all business activities.
• Responsible for corporate culture to include embracing and fostering company values.
• Supports company programs and initiatives; adheres to company policies and procedures.
• Represents the company to associates and the public.

Senior Director, Patient Services

Systems Engineer

• Managing day-to-day operations of CareMetx Internal Systems
• Mentoring and providing guidance to Service Desk team
• Managing vendor contracts
• Creating reports for End-User-Services (EUS)
• Developing recommendations for process improvements
• Cross training with other System Engineers
• Leading small IT Projects
• Presenting new projects or initiatives to Senior Leadership
• Designing, implementing, and troubleshooting call center telephony systems
• Proficient understanding of technology areas such as Azure Active Directory, MS InTune/MDM, Single Sign On/MFA
• Experience deploying and administering SaaS based cloud applications
• Providing technical support to applications and utility developers
• Responsible for backup and recovery of all IT infrastructure
• Ensuring system documentation is maintained
• Interacting with Tier 1/2 service desk to troubleshoot user and system issues.
• Providing after-hours infrastructure support, as needed.

Senior Engineer I, IT Systems

Solutions Engineer

• The Solution Architect II (SA II) role within the Implementations team independently designs and documents end-to-end solutions for CareMetx products and services.
• This role translates client program needs into operationally feasible, compliant, and scalable hub workflows with minimal guidance, applying growing expertise in solution design and healthcare hub operations.
• The SA II leads program discovery activities, drives the Implementation SOW process, and serves as a reliable solution contributor from Sales through Implementation go-live, while actively pursuing Senior SA responsibilities, competencies, and skills.
• Independently defines technical program solutions, timelines, and scope for standard CMTX offerings, with a solid understanding of client goals and CMTX organizational strategy.
• Partners with Product Management and Commercial team to coordinate cost/pricing inputs for the pricing model during the opportunity deal stage, ensuring costs submitted reflect solution scope, complexity, and staffing requirements.
• Map client requirements to standard hub operational capabilities, technology platforms, and workflows.
• Design end-to-end operational workflows covering all medical, pharmacy, and adherence services.
• Partner with Product Management to identify gaps between client expectations and standard CMTX offerings; document assumptions, constraints, out-of-scope items, and feasibility risks.
• Lead requirements intake and workflow design sessions with internal operational, technical, and compliance stakeholders.
• Facilitate program design reviews and obtain internal and external review and signature for the Program Rules Document.
• Support client escalations during implementation as they relate to solution and scope management, escalating complex issues to senior architects as appropriate.
• Maintain regular and reliable attendance, including being present, on time, and prepared for work as scheduled.

Solution Architect II

Recruitment

• Coordinate and schedule interviews across multiple time zones and teams
• Act as the primary point of contact for candidates throughout the interview process
• Manage applicant tracking system (ATS) data entry, updates, and reporting
• Prepare offer letters, initiate background checks, and manage pre-employment onboarding tasks
• Partner closely with Talent Acquisition team members to support sourcing initiatives
• Assist with career fair planning, recruitment events, and employer branding initiatives
• Maintain compliance with recruiting policies and procedures
• Shadow and support recruiters in sourcing candidates

Talent Acquisition Coordinator

Product Manager

• Work closely with Product Managers to develop product strategy
• Maintain the team backlog and facilitate customer conversations
• Participate in market research and analysis
• Collaborate with UX designers, UI, and engineering teams

Senior Product Owner

• Work closely with Product Managers to develop the overall product strategy
• Maintain the product roadmap
• Facilitate customer conversations to understand key pain points
• Participate in research and analysis of market & competition
• Own product initiatives and break them into a roadmap plan
• Collaborate with the product team to help drive product adoption
• Participate in solutioning sessions with architects, engineers, and designers

Product Owner

AI Engineer

• Provide strategic leadership and direction to 2 to 3 small, senior-caliber engineering teams
• Guide teams in understanding client needs, setting project goals, and ensuring successful implementation
• Manage 2–3 high-performing implementation teams of senior engineers
• Support the company’s rapid growth as we double our client base
• Drive delivery against the product roadmap
• Champion collaborations with TA and existing external sourcing vendors
• Refine onboarding methodologies
• Engage with organizational leaders to co-design and champion career progression frameworks
• Mentor an Engineering Talent Manager
• Dive deeper into analytics and connect the dots between talent metrics and broader business objectives
• Champion an AI-first engineering culture
• Facilitate the creation and management of data and information repositories
• Foster an environment of proactive domain-specific knowledge sharing among team members
• Pioneer refinements in delivery processes
• Advocate for and pursue expertise in advanced talent management strategies
• Maintain regular and reliable attendance

Senior Manager, AI Engineering

• Monitors employee job performance to ensure that all necessary tasks are completed in accordance with specifications and deadlines
• Conducts performance reviews and provides feedback to direct reports
• Provides day-to-day instructions to team members on job responsibilities
• Helps associates resolve work-related issues
• Assist with the hiring and termination process
• Assist with the development of program training documents
• Ensures open communication with the staff
• Proactively identifies program issues and proposes ways in which to address their concerns
• Maintains positive rapport with internal and external customers
• Understands contract obligations
• Analyzes reports for trends and gives recommendations
• Interact with key stakeholders within healthcare provider clinics, physician practices, or hospital outpatient locations
• Act as a liaison between healthcare provider offices and CareMetx program teams to support complex reimbursement cases
• Take the lead on complicated or escalated reimbursement cases in assigned territory, navigating options for both patients and providers to access prescribed therapies
• Validate Prior Authorization and Appeal Requirements and communicate as needed to stakeholders
• Track electronic payer billing codes for pharmacy and medical payers
• Develops Appeal Package for patient support program; ensures communication occurs between stakeholders on status of Appeal, if applicable
• Coordinates with patient support program representatives
• Assist program teams with handling escalated medical and pharmacy billing challenges
• Assist with resolving reimbursement challenges
• Provides information on relevant reimbursement topics related to our client’s products
• Educate clinics/physician’s offices on patient support program and services
• Effectively communicates with patients, family, provider, manufacturer and team members

Manager, Field Reimbursement

Customer Success Manager

• Serve as the primary strategic relationship owner and trusted advisor for all assigned manufacturer accounts and programs.
• Build and maintain relationships across multiple levels within the manufacturer: Commercial, Market Access, Medical Affairs, Marketing, and Finance.
• Lead all quarterly business reviews, strategic planning sessions, and executive touchpoints.
• Attend in-person client meetings, National Sales Meetings, and industry conferences.
• Host client dinners and/or educational events and networking opportunities.
• Act as connector for executive points of contact to others across the industry and CareMetx subject matter experts.
• Develop and manage HUB client portfolio strategy and roadmap, aligning our suite of products and services with brand and patient access goals.
• Partner cross-functionally with Operations, Technology/Product, Sales/Marketing, Legal, Compliance, and Finance to align HUB services execution and delivery with overall program strategy.
• Oversee budgeting, forecasting, and financial analysis in partnership with Finance.
• Responsible for regular client health updates and presentations to the ELT.
• Proactively identify risk, develop mitigation plans, and own pull-through on resolution.
• Partner closely with Operations teams to ensure all program SLAs, KPIs, and delivery deadlines are being met.
• Define reporting requirements and oversee development of dashboards and performance reports for internal stakeholders and senior leadership.
• Leverage HUB data and market analytics to inform patient access strategy, identify barriers, and drive program optimization.
• Support client implementations for new launches, special projects, and enhancements.

Director, Client Success

Business Intelligence Analyst

• Execute on the strategic vision set by the SVP of Business Intelligence for CareMetx’s Business Intelligence infrastructure, including data architecture, governance standards, and the long-term analytics roadmap.
• Partner with functional leaders across the organization to identify data needs, integrate information from disparate source systems, and deliver a unified data model that supports reporting and analytics functions.
• Lead, develop, and manage a team of analysts and report developers, providing mentorship, clear direction, and accountability in executing on BI initiatives.
• Oversee the design, development, and maintenance of enterprise data models, ETL/ELT pipelines, and relational database systems to ensure scalability and reliability.
• Direct the creation and delivery of dashboards, reports, and ad hoc analyses using data visualization tools, ensuring data products are accurate, timely, and actionable for business stakeholders.
• Serve as the organizational subject matter expert in healthcare data, including medical claims processing, payer transactions, and reimbursement workflows across commercial and government insurance programs.
• Collaborate with IT, operations, finance, and clinical teams to ensure data quality, consistency, and accessibility across the organization.
• Establish and enforce data governance standards, including data definitions, quality controls, and documentation practices across all BI systems and outputs.
• Evaluate and recommend technology investments to the SVP to advance the organization’s analytics capabilities, tooling, and data infrastructure.
• Translate complex data findings into clear, concise insights and recommendations for executive leadership and non-technical stakeholders.
• Maintain regular and reliable attendance, including being present, on time, and prepared for work as scheduled.
• Performs other related duties as assigned.