Strategic Account Operations Manager – Medical Prior Authorization

Role Overview

Reporting to the Director, Account Operations, the Strategic Account Operations Manager (Medical Prior Authorization) is responsible for overseeing complex customer relationships, programs, and initiatives focused on medical benefit prior authorization and front‑end access services.

We are seeking an experienced account operations leader with deep medical PA expertise and strong client‑facing operational experience to support strategic programs critical to Cover My Meds ’ evolving access strategy. This role will help build and mature CMM’s medical PA capabilities while ensuring high‑quality, scalable execution for assigned customers.

This position owns a portfolio of highly complex, strategic programs and serves as a trusted operational advisor to customers, internal stakeholders, and cross‑functional partners. The ideal candidate is comfortable operating in ambiguity, understands payer–provider–vendor dynamics, and can translate medical PA complexity into repeatable, operationally sound solutions.

• Serves as the primary point of contact for day‑to‑day oversight and management of multiple, complex, and strategic medical prior authorization and front end access programs, ensuring strong customer engagement, satisfaction, and retention
• Owns operational delivery of medical PA and front end access–related contract deliverables, ensuring adherence to contractual terms, service‑level expectations, and regulatory requirements
• Acts as the initial escalation point for complex program issues, independently researching, resolving, and communicating corrective actions; escalates appropriately and partners with internal teams as needed
• Develops, documents, and maintains program plans for medical PA and access services, tracking progress against goals, identifying operational risks, and implementing mitigation strategies
• Leverages medical benefit, payer policy, and prior authorization workflow knowledge to proactively identify trends, risks, and improvement opportunities across assigned programs
• Proactively utilizes data and reporting (payer metrics, authorization outcomes, turnaround times, denial trends, volume forecasts) to inform recommendations and operational decisions
• Drives a culture of continuous improvement and operational excellence, leading process optimization efforts related to medical PA workflows, front‑end services, and scaled support models
• Serves as a subject‑matter resource for medical PA within the Account Operations organization, advising peers and mentoring less‑experienced team members
• Partners cross‑functionally with Product, Network Services, Implementation, Support, Legal, Compliance, and Sales to ensure alignment between customer needs, product capabilities, and operational delivery
• Participates in and/or leads strategic initiatives tied to the evolution of CMM’s medical PA, access, and front‑end service offerings
• Represents Account Operations in customer‑facing discussions, including operational reviews, issue resolution meetings, and planning sessions
• Travel to client sites and industry events as needed (approximately 10–15%)

You are a seasoned account operations professional with hands‑on medical prior authorization experience who thrives in complex, fast‑paced environments. You are comfortable balancing operational rigor with relationship management and are energized by helping teams and customers navigate change. You bring a strong mix of analytical thinking, strategic problem‑solving, and collaborative leadership.

You are trusted by customers and internal partners alike as someone who understands how medical PA really works—and how to make it better.

• Bachelor’s degree or equivalent experience
• 7+ years of experience in account management, operations, or program leadership roles within healthcare
• Direct experience supporting medical prior authorization workflows, ideally within medical benefit (not pharmacy‑only) programs
• Strong understanding of payer policies, provider workflows, and prior authorization lifecycle concepts
• Demonstrated success managing complex, multi‑stakeholder programs and customer relationships
• Proven ability to…