Acts as the primary operational point of contact for clients, liaising between stakeholders and internal cross-functional teams to resolve issues. Responsible for tracking requests, analyzing reporting dashboards, and ensuring client performance guarantees are met.
Rightway
15 Remote Job Openings at Rightway
The Senior Director will define and execute the long-term strategy for Rightway's omnichannel member support organization across phone, chat, email, and digital channels. This role involves managing executive budgets, implementing AI-powered solutions, and partnering with Client Success to ensure operational excellence and member satisfaction.
Provide operational support for client relationships by managing the resolution of routine to complex service requests. Act as a liaison between client-facing teams and internal cross-functional departments to ensure performance guarantees are met.
Lead the design and delivery of a next-generation pharmacy benefits platform, owning technical initiatives from architecture to implementation. Mentor junior engineers and drive the adoption of AI-native development practices across the team.
Serve as the primary point of contact for members, providers, and pharmacies to resolve inquiries regarding pharmacy benefits, claims, and prior authorizations. Support clinical pharmacists with patient outreach and enrollment in clinical programs while documenting all interactions for quality assurance.
Acts as the primary contact for members and providers regarding specialty pharmacy benefits, prior authorizations, and navigation support. Supports Specialty Clinical Pharmacists with administrative tasks, patient enrollment in assistance programs, and medication adherence follow-ups.
Facilitate utilization management requests for coverage and enter authorizations into the claims platform. Coordinate with pharmacists and medical directors while managing member and provider communications regarding specialty pharmacy programs.
Define and deploy mission-critical data infrastructure and production-grade pipelines to process large healthcare datasets. Leverage AI tools and AWS services to optimize data transformations and improve platform reliability.
Design, build, and maintain scalable data models and products using dbt to support pharmacy benefit management and care navigation. Collaborate with cross-functional teams to transform complex healthcare data into trusted datasets for operational reporting and strategic decision-making.
Support the design, maintenance, and optimization of formularies and prior authorization criteria using data-informed recommendations. Integrate AI tools into clinical workflows to streamline operations and accelerate research and policy drafting.
Lead daily accounting operations including payables, billing, payroll, and general ledger reconciliations. Support monthly, quarterly, and year-end close processes while contributing to financial statements and audit preparations.
Lead the Application and Cloud Security functions to raise the security maturity of AWS systems and services. Architect defensive controls for AI/LLM capabilities and establish secure engineering patterns across the organization.
Own and evolve the vision for the digital pharmacy experience, focusing on member engagement and outcomes across web and mobile apps. Lead the development of features like drug search and cost transparency while mentoring an Associate Product Manager.
Lead a team of embedded analysts across PBM functions to deliver actionable insights and scalable data products. Partner with business leaders to align analytics workstreams with operational excellence and client success goals.
The Senior Manager will lead clinical consulting services and drive initiatives to improve pharmacy benefit plan performance. They will act as a subject matter expert, collaborating with internal teams and clients to enhance clinical outcomes and cost efficiency.
