Director of Health Plan Operations

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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