Role Description Reporting to the Manager of Pharmacy Operations, the Pharmacy Operations Specialist is primarily responsible for supporting the pharmacy utilization management programs, processing prior authorization requests, and providing pharmacy-related customer service to internal and external parties. In addition, the Operations Specialist will support the day-to-day operations of the pharmacy program as needed. Key Functions/Responsibilities - Receive, process, and review all prior authorization requests received through fax, phone, or electronic prior authorization systems in accordance with all regulatory and accreditation requirements. - Properly apply clinical policy criteria to the review of prior authorization requests. - Review and interpret member’s eligibility, claim history, and Pharmacy Program information using the PBM claims software to provide information to both internal and external clients via telephone or email. - Interpret medical and pharmacy data and accurately enter information into the system according to regulatory and NCQA accreditation requirements. - Communicate determinations to members and providers via incoming and outgoing telephone calls, fax notifications, and letter notifications. - Responsible for analysis and issue resolution as it pertains to the administration of the formulary and benefits. - Provide pharmacy-related customer service to both internal and external parties. - Process pharmacy authorizations utilizing PBM real-time online claims adjudication software. - Support new clinical program implementation. - Serve as a liaison to Member Services and other internal clients for real-time support on pharmacy benefit interpretation, Pharmacy Policy interpretation, and plan design interpretation. - Other responsibilities as needed. Qualifications - Minimum of a High School diploma or equivalent required. - Associate or Bachelor’s degree preferred. - Two or more years of experience in a professional or pharmacy setting. - Previous experience in a managed care environment preferred. - Prior customer service experience preferred. - Excellent Customer Service skills. - Prior experience assisting members and/or providers with telephone inquiries. - Strong organizational, problem-solving, communication, and interpersonal skills. - Excellent written and oral communication skills required. - Must have strong data entry and attention to detail in building cases. - Must be able to multitask and be results-oriented. Compensation Range $20.19 - $28.37. This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing. Note This range is based on Boston-area data and is subject to modification based on geographic location.

• Liderar un equipo de 1 supervisor y 6 analistas, estableciendo metodología de trabajo, criterios de priorización y estándares de entrega — y asegurando que el equipo tenga el contexto y la dirección para ejecutar con autonomía. • Levantar y documentar los Service Journey Maps de los procesos del centro de atención, identificando los factores causales por tipo de contacto con base en datos, como fundamento de todas las iniciativas de mejora. • Aplicar metodología COPC Lean Six Sigma (DMAIC) para diseñar e implementar mejoras de proceso con medición pre/post, con impacto directo en contact rate, FCR y DSAT. • Actuar como consultor interno del área de CS: traducir los hallazgos operativos en recomendaciones para el Head of CS y coordinar con equipos de producto, operaciones y BPOs la implementación de soluciones que requieren colaboración transversal. • Coordinar la integración operativa de nuevos productos en el ecosistema de atención: desde el diseño del journey hasta la configuración de flujos en Intercom y los sistemas de resolución. • Diseñar e implementar soluciones de automatización usando n8n, Retool e Intercom para eliminar pasos manuales y escalar la capacidad de resolución sin crecer el headcount.

Role Description The Director, Provider & Network Operations is responsible for providing guidance and oversight over network management including: - Provider Relations - Provider Contracting - Credentialing - Provider Data Integrity The Director will exhibit insight, innovation, and leadership to drive multiple strategies while continuously improving quality, financial viability, access, and provider satisfaction. The position will assist in developing, leading, aligning, and implementing the execution of tactical initiatives and strategies. In partnership with the Senior Vice President, CFO, and Senior Leadership, the Director will integrate provider network plans, activities, and policies throughout the department to meet company objectives. The position is responsible for monitoring all aspects of the network, provider performance, and trends to ensure networks are developed and suitable to meet business needs. The Director will serve as a liaison between the organization, hospital leaders, and physicians to develop, communicate, and execute strategic direction for the network. This position will also be directly involved in contracting discussions with larger and more complex partner arrangements. Qualifications - Bachelor's degree is required; master's degree desirable - Minimum 5 years of management experience - A minimum of 5 years of experience in provider contracting and provider relations - Must understand Medicare, RBRVS, case rate, capitation, and other related payment structures Requirements - Responsible for assuring the financial viability, overall service, and quality and performance of provider networks - Oversees the development and implementation of provider contracting strategies and negotiations - Leads provider contracting and servicing activities for business expansion - Develops and implements strategies to strengthen and/or develop new physician, hospital, and other provider relations - Defines provider network expansion requirements in new and existing geographic service areas - Approves and monitors special requests, retroactive adjustments, reimbursement, and contract exceptions - Modifies networks, contracts, reimbursements, credentialing standards, and utilization trends as needed - Collaborates with physicians and other organizations to develop mutually beneficial business opportunities - Maintains access to a high-quality, geographically desirable, cost-effective network of specialists, hospitals, and ancillary providers - Directs the implementation of new health plan contracts/product lines - Directs rate analysis, scope assessment, and geographic coverage assessment - Oversees all primary IPA, Medical Group, and Hospital market research - Oversees initiatives to engage with local or regional Accountable Care Organizations (ACOs) - Monitors industry changes, trends, and events to identify opportunities for market penetration and performance improvement - Oversees recruitment of providers for new networks - Ensures network providers meet quality, cost, and coverage standards - Develops and manages team and corresponding budget - Provides strategic direction to lead network development - Assists with provider relations activities as needed - Collaborates with internal teams to align network strategy with clinical and financial objectives - Updates and interfaces with senior leadership team on initiatives - Oversees the determination and implementation of any health plan or regulatory corrective action plans Benefits - Superior customer service support is essential - Excellent organizational and time management skills Diversity, Equity, and Inclusion Statement Community Health Options is committed to fostering, cultivating, and preserving a culture of diversity, equity, and inclusion (DEI). Our human capital is the single most valuable asset we have. The collective sum of individual differences, life experiences, knowledge, inventiveness, innovation, self-expression, unique capabilities, and talent our employees invest in their work represents a significant part of not only our culture, but our reputation and achievement as well. Community Health Options DEI initiatives are applicable, but not limited to, our practices and policies on recruitment and selection; compensation and benefits; professional development, and training; promotions; transfers; social and recreational programs, and the ongoing development of a work environment built upon the premise of DEI, which encourages and enforces: - Respectful, open communication and cooperation between all employees - Teamwork and participation, encouraging the representation of all groups and employee perspectives - Balanced approach to work culture through flexible schedules - Employer and employee contributions to the communities we serve

• Own inventory planning and forecasting across ~8,000 SKUs • Develop and maintain reorder point logic, safety stock levels, and inventory turn targets • Anticipate stockout risk and overstock exposure on 30/60/90-day horizons • Oversee SKU lifecycle management, including new titles, replacements, and discontinuations • Own all purchasing strategy and execution with publishers and suppliers • Standardize PO cadence, lead times, reorder processes, and communication workflows • Serve as primary operational owner of the 3PL partnership (Productiv) • Monitor and manage SLAs including pick accuracy, ship speed, and receiving accuracy • Oversee operational integrity of the product catalog, pricing rules, and category structure • Establish and monitor KPIs related to inventory health, margin, fulfillment efficiency, and cash usage