Director, Payor Operations
About The Position
The Director of Payor Operations will join Zócalo Health during a period of increasing payer complexity and operational scale. This role exists to ensure payer requirements are clearly 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 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 Plan-Level Performance Ownership 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 Diagnosis & Issue Resolution 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 Team Leadership (Plan Owners & Trainer) 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 Training Content & Change Enablement 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
Nice To Haves
- Experience working with CalAIM programs (ECM, Community Supports)
- Experience working across multiple health plans simultaneously
- Experience in high-growth or scaling organizations
Responsibilities
- 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
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.
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What This Job Offers
Job Type
Full-time
Career Level
Director
Education Level
No Education Listed
