Escalations Manager -Member Experience

at  VIVIO Health

Company Description
About VIVIO
VIVIO Health, a Public Benefit Corporation, is revolutionizing pharmacy benefits management through data and technology. Our foundational principle - “The Right Drug for the Right Person at the Right Price” - drives everything we do. Since 2016, our evidence-based approach has delivered superior health outcomes while reducing costs for self-insured employers and health plans. By ensuring each patient receives the most appropriate medication for their specific condition at a fair market price, we’re replacing the obsolete PBM Model with innovative solutions that work better for everyone.

Why Join VIVIO?

• Innovation: Challenge the status quo and shape healthcare’s future
• Impact: Directly influence patient care and help change healthcare delivery
• Mission: Join an organization that has a clear vision and mission.
• Collaboration: Work with passionate teammates dedicated to making a difference
• Growth: Expand your opportunities as we expand our business

Job Description
Overview:
We are seeking a proactive and results-driven Escalation Manager to join our team, focusing on handling patient care coordination escalations, identifying root causes, and ensuring smooth prioritization of issues. You will work to eliminate delays in members receiving their medications and ensure continuous improvement in our processes. This is an individual contributor role with opportunities to make an impact and grow. As a key member of the team, you will drive operational efficiency while leading initiatives to improve member experience.
Key Responsibilities:

Escalation Management and Prioritization:

• Experience in identifying, prioritizing, and managing high-priority issues, ensuring timely and effective resolutions for complex concerns.
• Act as a primary point of contact for escalated cases, ensuring smooth communication and swift problem-solving.
• Analyze and identify root causes of recurring issues to prevent future escalations.
• Prioritize issues based on urgency and impact, ensuring critical cases are addressed first, minimizing member disruptions.

Operational Leadership & Process Optimization:

• Manage day-to-day project workflows to optimize team performance and ensure timely issue resolution.
• Collaborate with team members to streamline processes, eliminating bottlenecks that delay medication fills or other member services.
• Implement process improvements to enhance operational efficiency, focusing on member satisfaction and case resolution.
• Ensure all processes adhere to organizational policies, procedures, and healthcare regulations.

Performance Monitoring & Reporting:

• Track key performance metrics (KPIs) for case resolution, member satisfaction, and operational efficiency.
• Conduct regular audits to assess performance, identify improvement areas, and create action plans.
• Provide data-driven insights and recommendations to leadership to ensure team goals are met.

Team Support & Development:

• Provide guidance and support to team members working on escalated cases, fostering a problem-solving mindset.
• Collaborate with other Operation leaders and the trainer to ensure team members have the skills to handle complex inquiries effectively.

Collaboration & Communication:

• Foster effective communication across teams, ensuring clear understanding of project goals and updates.
• Work cross-functionally with other departments (e.g., healthcare providers, pharmacies) to resolve member issues and optimize service delivery.
• Proactively communicate with leadership on progress, challenges, and solutions to maintain alignment.

Qualifications

Qualifications:

• 5 years of experience in healthcare, with a focus on escalation resolution, care coordination, member advocacy, or case management. Prior experience in Rx management/ Pharmacy Patient Care Coordination is highly preferred.
• Minimum 5 years of experience leading teams in a healthcare or remote call center setting.
• Strong analytical and problem-solving skills with the ability to resolve complex issues and drive process improvements.
• Experience in handling escalations and optimizing operational workflows.
• The candidate must demonstrate a strong commitment to being available for a role that requires on-call readiness.
• Excellent communication skills, with the ability to articulate complex issues and solutions to stakeholders at all levels.
• Strong organizational skills and the ability to prioritize multiple tasks effectively.
• Proficiency in Microsoft Office Applications (Word, PowerPoint, Excel, Outlook, Teams).
• An active problem-solver with a “figure it out” mindset.
• Availability to travel for VIVIO-related meetings, and training as needed.
• An associate’s degree or higher in business administration, management, or a related field is required. A bachelor’s degree is preferred.

Please refer the Job description for details