Manager, Member Services – Medication Access & Support Programs

5+ years of experience in healthcare operations, member services, pharmacy operations, or insurance support. 2+ years of people management experience in complex, high volume support environments. Strong understanding of pharmacy fulfillment, insurance coverage, and medication access workflows. Proven ability to manage operational risk, escalations, and cross functional dependencies. Strong leadership, communication, and decision making skills. Experience leading teams supporting specialty or high demand medications (preferred). Background in prior authorization, benefit investigation, or pharmacy partnerships (preferred). Experience scaling new programs or standing up new service lines (preferred). Experience with Zendesk or other CX tools (preferred). Fluency in Spanish or another commonly spoken member language (preferred).

Lead, coach, and develop Team Leads and Member Services Associates. Set clear expectations for quality, productivity, and member experience. Own hiring, onboarding, performance management, and career development. Foster a culture of accountability, empathy, and continuous improvement. Own performance outcomes for medication access (resolution time, pharmacy turnaround, quality, member satisfaction). Ensure consistent execution of pharmacy coordination, insurance navigation, and escalation workflows. Partner with Workforce Management on staffing, headcount, and capacity. Serve as primary operational partner for pharmacy vendors. Collaborate with clinical operations, product, legal, and risk teams. Represent Member Services in cross-functional forums. Own operational risk management, compliance adherence, and audit readiness. Serve as escalation owner for high impact issues. Ensure adherence to privacy and scope requirements. Identify trends and friction points in workflows. Lead process improvements, tooling enhancements, and documentation updates. Drive change management. Support program scaling.