ApplyDirector of Health Plan Operations
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💎 Seniority level: Director, 7-10+ years
📍 Location: US
💸 Salary: 130000.0 - 160000.0 USD per year
🔍 Industry: Telehealth mental and behavioral health services
🏢 Company: Cartwheel👥 1-10💰 $5,600,000 Seed 9 months ago
🗣️ Languages: English
⏳ Experience: 7-10+ years
🪄 Skills: LeadershipProject ManagementData AnalysisPeople ManagementCross-functional Team LeadershipOperations ManagementRDBMSCommunication SkillsCustomer serviceRESTful APIsNegotiationComplianceMS OfficeRelationship managementRisk ManagementTeam managementStakeholder managementStrategic thinkingProcess improvementFinancial analysisBudget management
Requirements:
- 7-10+ years of health plan operations experience, including group contracting, payer enrollment and provider credentialing, and compliance
- Strong preference for experience with virtual / telehealth mental and behavioral health services
- Thrives in a world of rapid startup growth
- Achieves quality results quickly and prioritizes outcomes
- Uses data to drive decisions, and has a keen understanding of dashboards and metrics
- In the face of competing priorities, prioritizes and moves forward without getting stuck
- Seamlessly transitions between strategic thinking and hands-on operations
Responsibilities:
- Manage all payer relationships and contracting, including upfront contracting, ongoing contract negotiation, and appropriate escalation and resolution of issues
- Establish and oversee processes to ensure compliance with legal and regulatory requirements and build a culture of compliance in partnership with operations and clinical leadership
- Ensure Cartwheel is an in-network provider with all state Medicaid, MCO, and commercial payers in the states in which we operate and the states to which we plan to expand
- Oversee a team responsible for payer enrollment, provider credentialing, and provider licensing, ensuring strong performance
- Maintain accurate records of Cartwheel’s network status with payers and individual clinicians’ credentialing status
- Partner effectively with RCM team to achieve key performance metrics including reimbursement rates and collections rate
- Collaborate with teams across Cartwheel including Business Operations, Care Operations, Clinical Operations, People & Culture, and Technology
- Continually evaluate health plan operations processes and implement improvements for efficient scale as Cartwheel grows
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