Director, Payor Operations
Zócalo Health
full-time
Posted on:
Location Type: Remote
Location: United States
Visit company websiteExplore more
Salary
💰 $160,000 - $165,000 per year
Job Level
About the role
- Own and maintain a centralized payer rulebook across all health plans
- Interpret payer requirements and translate them into clear operational workflows
- Standardize workflows where possible while maintaining plan-specific requirements
- Continuously update workflows as requirements evolve
- Own performance outcomes 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
- Diagnose root cause of issues (execution vs workflow vs capacity vs quality)
- Assign ownership and track resolution
- Lead corrective actions for underperforming plans
- Escalate systemic issues across plans
- Manage L4 Plan Owners responsible for plan-level oversight
- Define expectations for monitoring, escalation, and issue tracking
- Oversee Payor Ops Trainer responsible for content development and rollout support
- Ensure team operates with clarity and consistent ownership boundaries
- Ensure payer requirements are translated into training-ready materials
- Support rollout of workflow changes in partnership with CHW Workforce
- Ensure plan-specific nuances are accurately captured
- Validate that training content reflects current payer requirements
Requirements
- 7–10+ years of experience in healthcare operations, payer operations, compliance, or related functions
- Strong working knowledge of Medicaid 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 capacity
- Experience managing complex, cross-functional work without direct authority over execution teams.
Benefits
- Equity compensation package
- Comprehensive benefits including medical, dental, and vision
- 401k
- Flexible PTO policy - take the time you need to recharge
- $1,000 home office stipend
- We provide the equipment needed for this role.
- Opportunity for rapid career progression with plenty of room for personal growth.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
healthcare operationspayer operationscomplianceoperational workflowsauditquality assuranceanalytical skillsissue diagnosisperformance monitoringworkflow standardization
Soft Skills
leadershipstakeholder managementaccountabilitycommunicationproblem-solvingcross-functional collaborationtraining developmentclarity in ownershipadaptabilityperformance management