[Hiring] Operations Manager @VIVIO Health

Role Description

The Operations Manager, Member Experience supports the overall operations of VIVIO's Member Experience organization and issue resolution and quality. In this client-facing role, the manager works directly with clients, consultants, and vendors on member-facing issues, owning each from first notice to final resolution:

• Strong root cause analyst who looks past individual complaints to find and fix underlying process, system, policy, or training gaps.
• Core focus on member issue resolution, quality, and AI tool oversight.
• Supports Member Experience operations wherever the business needs it as VIVIO grows.

Key Responsibilities

• Client, Consultant and Vendor Partnership:
  • Serve as a primary point of contact for clients, consultants, and vendors on member-facing issues, owning communication from intake to resolution with clear, proactive updates.
  • Lead issue review calls and deliver written resolution summaries covering timeline, member impact, root cause, corrective actions, and follow-up commitments.
  • Handle difficult conversations with composure and empathy, balancing partner expectations with contract terms, regulatory requirements, and operational realities.
  • Build trusted relationships and present issue trends, quality results, and improvements in client and consultant business reviews.
• Member Issue Resolution and Escalations:
  • Prioritize member-facing issues by urgency and impact to minimize medication delays, and serve as the final internal escalation point for complex member, pharmacy, prescriber, and payer issues.
  • Coordinate with providers, pharmacies, vendors, and internal teams to resolve cases and confirm the member outcome before closure.
  • Maintain intake, triage, SLA and documentation standards, and streamline workflows that delay medication fills or other member services.
  • Track KPIs (volume, time to resolution, SLA adherence, repeat issues, satisfaction) and audit case handling to drive improvement plans.
• Root Cause Analysis and Continuous Improvement:
  • Lead structured root cause analysis on issues, escalations, complaints, quality failures, and incidents using methods such as 5 Whys, fishbone diagrams, Pareto analysis, and process mapping.
  • Separate symptoms from underlying causes (process, system, data, policy, vendor, or training) and validate findings with data.
  • Own corrective and preventive action (CAPA) plans with clear owners, deadlines, and success measures, and confirm fixes are sustained.
  • Analyze trends to catch recurring failure points and emerging risks early, and partner with cross-functional teams to fix problems at the source.
• Quality and Compliance:
  • Lead the quality program, including call and case audits, scorecards, evaluator calibration, and timely, constructive feedback.
  • Ensure adherence to policies, client and payer contracts, HIPAA, and healthcare regulations; support internal, external, and client audits.
  • Turn quality findings into root cause inputs, training recommendations, job aids, and updated SOPs.
• AI Tool Oversight:
  • Serve as the team's expert on VIVIO's AI tool and coach staff on using it well.
  • Review AI-assisted interactions for accuracy and compliance, partner with technology to improve the tool, and identify automation opportunities that reduce repeat issues and strengthen quality.
• Leadership, Reporting and Collaboration:
  • Coach and develop team leads and staff; manage schedules, goals, and performance reviews, and build a culture of ownership and member-first service.
  • Report issue, escalation, quality, and root cause trends to leadership with data-driven insights and progress on corrective actions.

Qualifications

• 3+ years in member experience, PBM, pharmacy claims, or related healthcare operations.
• 2+ years managing teams in a queue-based or contact center environment, including escalations or quality assurance.
• Client-facing experience resolving member-facing issues directly with clients, consultants, or vendors and communicating resolution and root cause.
• Proven root cause analysis experience, with concrete examples of sustainable corrective actions.
• Knowledge of prior authorization, coordination of benefits, pharmacy claim rejections, and HIPAA.
• Proficiency with CRM or claims systems and Excel (including pivot tables); high school diploma or equivalent.

Preferred

• Bachelor's degree in healthcare administration, business, or a related field.
• Specialty pharmacy, mail order, or long-term care experience.
• Experience presenting to clients or executives.

Skills and Competencies

• Client presence: a polished, composed communicator who explains complex issues simply and earns partner trust.
• Root cause analysis: curious and analytical; asks why until the real cause is found and backs it with data.
• Ownership and follow-through: sees every issue and corrective action through to a verified fix.
• Operational judgment: prioritizes well and makes sound decisions under pressure.
• Leadership and coaching: develops people and builds accountable teams.
• Adaptability: ready to take on new areas of Member Experience as the business evolves.

Working Conditions

• Remote, with extended computer and phone use.
• On-call for urgent escalations and occasional extended hours, including partner calls outside business hours.
• Limited travel for VIVIO meetings, training, and client or vendor visits.

Benefits

• Base Salary: $75-85K/year base.
• Bonus eligible.
• Health benefits.
• 401K with employer match.
• Stock options.
• PTO.
• Opportunity to work in a fast-moving, collaborative, and innovative company.