CareMetx, LLC

Manager

• 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.

Senior Director, Business Intelligence

• Acts as a single point of contact and voice for all providers and patients.
• Works as a patient advocate and always demonstrates compassion
• Serves as a patient advocate and enhances the caller/contact experience
• Coordinates access to therapies, conducts appropriate follow up and facilitates access to appropriate support services
• Manages case load depending on the parameters of the program
• Collects and review all patient information, to the degree authorized by the SOP of the program
• Validates completeness of all required information and provides assistance to provider and/or patient
• Provide guidance to physician office staff and patients on how to complete and submit all necessary program applications in a timely manner
• Determines patient’s eligibility and conducts patient enrollment activities (example patient assistance programs and copay assistance)
• Performs reimbursement related activities such as benefit investigations, prior authorizations, appeals, etc.
• Provide exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly
• Maintain frequent phone contact with patients, provider representatives, third party customer service representatives and pharmacy staff
• Provides reimbursement information to providers and/or patients
• Reports all Adverse Events (AE) disclosed in alignment with training and Standard Operational Procedures (SOP)
• Coordinate with inter-departmental associates as necessary
• Work on problems of moderate scope where analysis of data requires a review of a variety of factors.
• Exercise judgment within defined standard operating procedures to determine appropriate action
• Typically receives little instruction on day-to-day work, general instructions on new assignments
• Extensive knowledge of HIPAA regulations and follows all company policies
• Maintain regular and reliable attendance, including being present, on time, and prepared for work as scheduled.
• Performs other related duties as assigned.

Reimbursement Case Manager

Compliance

• The Compliance Coordinator provides essential operational and administrative support to the CareMetx Compliance and Risk Management team.
• This role plays a critical part in maintaining the integrity of CareMetx’s Quality Management System (QMS), supporting defect and CAPA management processes, facilitating internal and external audit activities, and ensuring vendor records and compliance documentation remain current and complete.
• The Compliance Coordinator also supports the team’s use of AI tools to improve process efficiency, documentation quality, and operational effectiveness across the compliance program.
• QMS Administration: Process document creation, revision, and archival requests for all CareMetx programs and departments within the QMS in accordance with document control procedures.
• Maintain QMS user account records, including program assignments and role updates.
• Run QMS reports to monitor process adherence, training completion, and record status as directed.
• Enter and maintain training assignments in the QMS.
• Vendor Management Support: Track vendor training compliance status and follow up on outstanding documentation or certification gaps.
• Assist with preparation of vendor meeting notes, spot-check documentation, and vendor management reporting.
• Defect and CAPA Record Support: Assist with the initiation, documentation, and administrative tracking of defect and deviation records in the QMS.
• Support CAPA documentation, including tracking corrective and preventive action items to closure and flagging overdue items to the appropriate team member.
• Prepare known deviation (KD) records and associated summaries in the formats required by the QMS for each record subtype.
• Audit and Inspection Support: Assist with evidence gathering, document retrieval, and report preparation for internal and external audits and client quality assessments.
• AI-Assisted Process Support: Utilize company-authorized AI tools to support documentation drafting, record summarization, and template-based work product development under the direction of the compliance team.
• Identify opportunities to streamline repetitive compliance administrative tasks through AI-assisted workflows and bring recommendations to the team for evaluation and approval.
• Apply critical review to AI-generated output to ensure accuracy, completeness, and alignment with QMS standards and CareMetx policy prior to submission or use.
• General Compliance Operations: Maintain organized records of compliance activities, correspondence, and program documentation in the QMS and associated systems.
• Assist with coordination of compliance team meetings, including scheduling, agenda preparation, and note-taking.
• Perform other compliance and risk management administrative tasks as assigned.
• Maintain and track licensure records, including renewals and regulatory filings, to ensure timely compliance.

Compliance Coordinator

QA Engineer

• Define, own, and continuously evolve a comprehensive, multi-year QA strategy for end-to-end testing across multi-system healthcare technology platform.
• Design and lead testing strategies for complex cross-team workflows involving multiple systems, ensuring thorough coverage of integration points and data flows.
• Establish quality metrics, KPIs, and executive-level reporting dashboards to provide full visibility into quality status across all products, teams, and initiatives.
• Set and enforce test documentation standards, templates, and best practices adopted across the organization.
• Proactively identify systemic quality risks across the portfolio and develop mitigation plans before they impact delivery or production.

Senior QA Manager, Product Engineering

Learning and Development

• Schedule and administer new employee orientations; ensure all new hires complete required onboarding training within established timelines.
• Map out annual training plans and schedules for all applicable areas, including new hire onboarding, leadership development, and ongoing professional development.
• Design, develop, and implement training programs aligned with organizational priorities and employee performance needs.
• Select appropriate training methods and delivery formats, including instructor-led training (ILT), virtual instructor-led training (vILT), e-learning, job shadowing, mentoring, and blended learning approaches.
• Coordinate logistics for training events: booking venues or virtual platforms, arranging equipment, preparing materials, and communicating schedules to participants.
• Maintain and update a centralized online library of training materials, e-learning modules, SOPs, and reference guides.
• Act as an Administrator for the company's Learning Management System (LMS) -- uploading content, enrolling learners, tracking completion, and generating reports.
• Partner with department managers, HR Business Partners, and senior leadership to identify training needs through job analysis, performance reviews, and workforce assessments.
• Collaborate with subject matter experts (SMEs) to develop accurate, relevant, and engaging training content and materials.
• Assess and anticipate future training needs based on organizational changes, new technology rollouts, regulatory requirements, and business growth plans.
• Facilitate or co-facilitate training workshops, seminars, and new hire orientation sessions as needed.
• Partner with the appropriate team to market available training opportunities to employees and provide clear information on registration, prerequisites, and expectations.
• In partnership with the Talent Development Strategy Director, coordinate and communicate with external training vendors, consultants, and providers; evaluate vendor performance and manage contracts.
• Evaluate training program effectiveness using participant feedback, assessments, post-training surveys, and performance data (e.g., Kirkpatrick model or similar frameworks).
• Monitor, evaluate, and document training activities, completion rates, and outcomes; prepare regular reports for HR leadership and department heads.
• Capture data based on surveys, assessments, learner satisfaction, and other relevant measurements.
• Analyze training data and recommend improvements to program content, delivery methods, and scheduling.
• Ensure training records are accurate, complete, and audit-ready in accordance with regulatory and company requirements.
• Maintain accurate and confidential training records, certifications, and compliance documentation.
• Keep current on training trends, learning technologies, industry developments, and regulatory changes; incorporate best practices into training strategies.
• Maintain regular and reliable attendance, including being present, on time, and prepared for work as scheduled.
• Other duties as assigned.

Talent Development Training Specialist

Operations

• 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
• Assist with the coaching of staff
• Provides day-to-day instructions to team members on job responsibilities
• Helps associates resolve associate 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
• Assist in the development of project task plan and standard operating procedures
• Analyzes reports for trends and gives recommendations
• 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.

Operations Supervisor

Project Manager

• Responsible for the planning, execution, and delivery of assigned projects
• Responsible for managing projects to defined scope and contract requirements
• Takes ownership to lead and directly manage all aspects of project delivery, working with matrixed partners to ensure successful project completion
• Serve as a subject matter expert in routinely briefing key stakeholders on different aspects of assigned initiatives
• Continuously interact and consult with all functions and levels of management ensuring effective ongoing communications across teams and stakeholders
• Establish and maintain essential project documentation
• Define and track project milestones by creating, maintaining, and reporting on an overall integrated project plan
• Ensure projects adhere to PMO Standard Operating Procedures (SOPs), developing and maintaining required artifacts
• Rigorously manage scope to ensure commitments are achieved within agreed timeline, cost, and quality parameters
• Proactively anticipate, identify, and manage risks and issues of projects escalating as needed
• Publish regular project status reports to ensure the project’s overall direction and integrity
• Ensure stakeholders are adequately consulted or engaged on key deliverables for their respective functional areas
• Lead weekly project team and periodic stakeholder meetings to assess and review progress with key constituents
• Track and manage project budget for resource hours and internal costs
• Actively collaborating across departments as needed to achieve project goals
• Propose recommendations and adjustments to improve project delivery and the PMO department
• Effectively manage and prioritize your time to meet deadlines in a fast-paced environment
• Travel may be required for project-related client meetings and training

Revenue Operations

• The Revenue Manager leads CareMetx’s revenue accounting and accounts receivable function, managing a team of accounting staff and owning the end-to-end revenue cycle.
• Reporting to senior Finance leadership, this role combines strategic oversight with cross-functional collaboration to ensure the integrity of revenue reporting, the efficiency of billing and collections operations, and the professional development of the team.
• The Revenue Manager sets priorities, drives process improvements, and serves as the primary point of accountability for revenue-related financial controls and compliance.
• Manage and develop a team of revenue accounting staff, including hiring, onboarding, performance management, goal-setting, and day-to-day coaching.
• Own the month-end close for revenue, directing staff execution of journal entries, reconciliations, and revenue schedules while reviewing for accuracy, completeness, and GAAP compliance before submission.
• Provide strategic oversight of the Accounts Receivable function, setting collection targets, monitoring AR aging and KPIs, and escalating issues to Sales and Account Management leadership as needed.
• Serve as the senior authority on client invoicing policy and the Sage contracts module, establishing standards and controls for invoice review and approval across the team.
• Lead the annual audit for all revenue and AR areas, coordinating team deliverables, managing timelines, and serving as the primary contact for external auditors.
• Build and maintain strong partnerships with Sales, Account Management, Legal, and Operations, representing Finance in cross-functional discussions on contract terms, billing structures, and revenue recognition.
• Identify and lead process improvement and automation initiatives across the revenue cycle, driving efficiency gains and scalability as CareMetx grows.
• Maintain regular and reliable attendance and perform other duties as assigned.

Revenue Manager

Payroll

• Process bi-weekly payroll for 1,800+ employees across multiple states, ensuring accuracy, compliance, and on-time delivery for each pay cycle
• Manage payroll tax obligations including preparation and reconciliation of quarterly 941s, state tax filings, and year-end W-2/W-3 processing and distribution
• Administer complex payroll items including garnishments, child support orders, wage levies, and benefit deductions (401k, HSA, FSA, health premiums)
• Audit and reconcile large payroll runs prior to submission, identifying and resolving discrepancies, overpayments, and data integrity issues across a high-volume employee population
• Respond to employee payroll questions and escalate complex issues as needed
• Partner with Human Resources to ensure accurate employee data and seamless processes
• Support payroll audits, including gathering and organizing required documentation
• Identify and recommend process improvements to payroll procedures
• Review and process employee travel and expense reimbursements, ensuring submissions adhere to company policy, supporting documentation requirements, and timely disbursement
• Support special projects and other duties as assigned

Payroll Specialist

• Evaluate individual, and team strengths and weaknesses to identify trends, coaching opportunities, and advise management and client of training needs
• Develop classroom handouts, instructional materials, job aids and user manuals related to business and system processes
• Direct structured learning experiences and monitor quality results for delivery to management
• Deliver team training courses to coincide with corporate initiatives and Core Values
• Assess training effectiveness through various methodologies to ensure retention and adoption of taught skills and techniques, into employee work behavior
• Evaluate existing ongoing programs to advise as to necessary changes
• Partner with the Quality Department to ensure the team maintains the highest levels of performance, quality, and service standards, based upon defined metrics
• Co-own with Operations, documentation of trainee performance, at calendar intervals after classroom instruction
• Provide compliance updates and refresher training as assessed and needed
• Measure, track, and evaluate employee progress through the training curriculum to assess if the individual is ready to perform the needed work
• Conduct training sessions via both web-based, and face-to-face learning
• Provide employee development through constructive feedback, coaching, training/developing, and applying mentorship techniques
• Partner with the Quality Department to identify trends for training and coaching
• Conduct training role playing exercises to reinforce proper behavior and performance
• Measure success of training through various methodologies such as improved quality scores, reduction in errors on scheduled trips, improvement in employee retention rates
• Perform day-to-day project management of current and future training initiatives
• Develop instructional material to maintain the highest levels of performance, quality and service, based on defined metrics
• Design and create content that aligns with instructional end goals and objectives
• Maintain regular and reliable attendance, including being present, on time, and prepared for work as scheduled.
• Performs other related duties as assigned.

Training Coordinator

Attorney

• Review, draft, and negotiate a wide variety of commercial agreements, including master services agreements, statements of work, vendor agreements, non-disclosure agreements, and regulatory and compliance addendums.
• Manage end-to-end contract negotiations with clients, vendors, and other counterparties from initial redline through execution.
• Advise internal stakeholders on contract terms, legal risks, and negotiation strategy, translating complex legal concepts into clear, actionable guidance.
• Collaborate closely with cross-functional partners to support business objectives and ensure alignment on contractual commitments.
• Maintain and improve contract templates, playbooks, and standard fallback positions to promote consistency and efficiency across the contracting function.
• Support contract lifecycle management including tracking contract milestones and renewals.
• Identify and escalate legal and compliance issues as needed.

Commercial Attorney

• Review, draft, and negotiate a wide variety of complex commercial agreements, including master services agreements, statements of work, agreements with SaaS and other information technology service providers, vendor agreements, non-disclosure agreements, business associate agreements, information security, privacy, and other regulatory and compliance addendums, and amendments.
• Manage end-to-end contract negotiations with clients, vendors, and other counterparties from initial redline through execution, independently driving transactions to timely completion, including high-stakes or high-complexity matters.
• Advise internal stakeholders and senior leadership on contract terms, legal risks, regulatory exposure, and negotiation strategy, translating complex legal and regulatory concepts into clear, actionable guidance for non-legal audiences.
• Provide substantive guidance on healthcare regulatory matters relevant to CareMetx’s business, including federal and state fraud, waste, and abuse laws (e.g., Anti-Kickback Statute, False Claims Act), the Stark Law, pharmacy laws and regulations, and applicable data privacy and security requirements (e.g., HIPAA, state privacy laws).
• Collaborate closely with cross-functional partners in sales, finance, accounting, operations, IT, human resources, and other corporate functions to support business objectives and ensure alignment on contractual and regulatory commitments.
• Develop, maintain, and improve contract templates, playbooks, standard fallback positions, and compliance guidance to promote consistency, efficiency, and regulatory soundness across the contracting and legal functions.
• Support and mentor junior legal staff, providing guidance on contract drafting, negotiation strategy, contract lifecycle management, and regulatory issues.

Senior Commercial Attorney

• 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 for patients
• Validate Prior Authorization and Appeal Requirements and communicate as needed to stakeholders
• Track electronic payer billing codes for pharmacy and medical payers
• Develop 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
• Provides exceptional customer service to internal and external customers resolves any customer request in a timely and accurate manner, escalates complaints accordingly
• Assist in development of standard operating procedures regarding payer creation, payer database management and prior authorization forms library
• Verifies transactions and processes comply with organizational and departmental policies and procedures; suggests changes and solutions as appropriate
• Independently and effectively resolves complex accounts with minimal supervision
• Handles complex issues where analysis of situations or data requires an in-depth evaluation of variable factors
• Networks with key contacts outside their own area of expertise
• Acts independently to determine methods and procedures on new or special assignments
• Exercises judgment in selecting methods, techniques and evaluation criteria for obtaining results
• Maintain regular and reliable attendance, including being present, on time, and prepared for work as scheduled
• Performs related duties as assigned