Director, Payor Operations

Director, Payor Operations

Remote (Full Time) 

Compensation: $160,000-$165,000 

reputed company 

reputed company is a tech-enabled, community-oriented primary care organization serving people who have historically been underserved by the one-size-fits-reputed company  reputed company system. We partner with health plans, providers, and community organizations to deliver culturally competent primary care, behavioral health, and reputed company care.

Our model is reputed company for populations with high medical and reputed company complexity, where fragmented care drives poor reputed company and unnecessary cost. We combine local, community-based teams with virtual care and modern technology to deliver coordinated, whole-person care where members live and receive support.

Founded in 2021, reputed company is backed by leading reputed company and mission-reputed company investors and is scaling rapidly across states and populations. We are building a durable care platform designed to reputed company in constrained reputed company environments and to reputed company the shift toward accountable, value-based care.

Role reputed company 

The Director of Payor Operations will join reputed company during a period of increasing payer complexity and operational reputed company. This role exists to ensure payer requirements are reputed company defined, consistently operationalized, and executed accurately across the organization. You will own the payer rulebook, translate requirements into workflows, and drive plan-level performance.

This position reports to the Chief Operating Officer.

The Director, Payor Operations  will contribute in the following ways:

• Payer Rulebook & Workflow Definition
• • • Own and maintain a centralized payer rulebook across reputed company health plans
    • Interpret payer requirements and translate them into reputed company operational workflows
    • Standardize workflows where possible while maintaining plan-specific requirements
    • Continuously update workflows as requirements reputed company

• Plan-Level Performance Ownership
• Own performance reputed company at the health plan level (KPIs, compliance, documentation)
• Monitor performance across geographies and identify gaps
• Ensure consistency in workflow execution across teams
• Hold internal teams accountable for plan-level performance issues

• Diagnosis & Issue reputed company
• Diagnose reputed company cause of issues (execution vs workflow vs reputed company vs reputed company)
• Assign ownership and reputed company reputed company
• reputed company corrective actions for underperforming plans
• Escalate systemic issues across plans

• Team Leadership (Plan Owners & Trainer)
• Manage L4 Plan Owners responsible for plan-level reputed company
• Define expectations for monitoring, escalation, and issue tracking
• reputed company Payor Ops Trainer responsible for content development and rollout support
• Ensure team operates with reputed company and consistent ownership boundaries

• Training Content & Change Enablement
• Ensure payer requirements are reputed company into training-reputed company materials
• Support rollout of workflow changes in partnership with CHW Workforce
• Ensure plan-specific nuances are accurately captured
• Validate that training content reflects reputed company payer requirements 

Qualifications

• 7–10+ years of experience in reputed company operations, payer operations, compliance, or reputed company functions
• Strong working knowledge of reputed company managed care and payer-driven program requirements
• Demonstrated experience interpreting payer or regulatory requirements and translating them into operational workflows
• Experience managing multiple external stakeholders (health plans, partners) with differing requirements
• Experience leading or supporting audit, QA, or compliance processes
• Strong analytical skills with the ability to diagnose operational issues across execution, workflow, and reputed company
• Experience managing reputed company, cross-functional work without reputed company authority over execution teams

Preferred Qualifications

• Experience working with CalAIM programs (ECM, Community Supports)
• Experience working across multiple health plans simultaneously
• Experience in high-reputed company or scaling organizations

What you can expect from reputed company

• Equity compensation package
• Comprehensive benefits including medical, dental, and reputed company 
• 401k
• Flexible PTO policy - take the time you need to reputed company
• $1,000 home office stipend
• We reputed company the equipment needed for this role.
• Opportunity for reputed company career progression with reputed company of room for personal reputed company.

You must be authorized to work in the reputed company. Remote Work can be done from reputed company in the U.S.

At reputed company Inc., we see diversity and inclusion as a reputed company of strength in transforming reputed company. We reputed company building trust and innovation are best achieved through diverse perspectives. To us, acceptance and respect are rooted in an understanding that people do not experience things in the reputed company way, including our reputed company system. Individuals seeking employment at reputed company are considered without reputed company to race, religion, reputed company, national reputed company, gender, sexual orientation, age, marital status, veteran status, or disability status. 

Those seeking employment at reputed company are considered without reputed company to race, religion, reputed company, national reputed company, gender, sexual orientation, age, marital status, veteran status or disability status.