Manager, Payer Enrollments

Pomelo Care

3d • $95,000 - $115,000 • Remote

About The Position

Pomelo Care is a virtual medical practice for women and children, providing care across pregnancy, postpartum, pediatrics, menopause, and perimenopause. The Manager, Payer Enrollments will contribute to the strategy and own execution of payer enrollments in new and existing markets for the midlife program, as well as own licensing execution for midlife providers. Reporting to the Director, Operations and Clinical Quality, this role manages licensing and credentialing specialists and oversees provider licensing, credentialing, and enrollment with states and health plan partners. The role collaborates across clinical, customer success, and market operations teams, works with a third-party licensing vendor, and leads related audit activities.

Requirements

• At least 3 years of experience enrolling APPs, therapists, registered dietitians, physicians, and/or doulas with payers.
• At least 2 years of healthcare operations experience, ideally in healthcare delivery or a high-growth startup.
• At least 2 years of people management experience.
• At least 1 year of experience managing licensing, credentialing, and enrollment activities.
• Exceptional project management and prioritization skills.
• Results-oriented approach and ability to move quickly.
• Meticulous attention to detail.
• Comfort with ambiguity.
• Ability to work cross-functionally with clinicians, technical teams, and external vendors or contacts.
• Passion for women's health.

Responsibilities

• Manage a team of licensing and credentialing specialists.
• Oversee the end-to-end process for licensing, credentialing, and enrolling providers with states and health plan partners within the midlife offering.
• Partner with the Director, Operations and Clinical Quality to own enrollment strategy across clinical specialties, payers, and geographic states, ensuring adequate coverage and access to care for midlife patients.
• Use data to proactively identify gaps in processes and clinician enrollment coverage.
• Identify and implement process improvements internally and with third parties.
• Work cross-functionally with customer success, market operations, and clinical teams to achieve enrollment goals.
• Manage the relationship with the third-party licensing vendor, including holding the vendor accountable to service-level agreements.
• Lead audits related to midlife licensing, credentialing, and enrollment, including delegated credentialing agreements.

Benefits

• Comprehensive health, dental, and vision coverage for employees and their families.
• High-deductible health plans with Health Savings Account (HSA) options.
• Flexible Spending Account (FSA).
• Equity grant participation.
• 401(k) program.
• Competitive vacation policy.
• 16 weeks of paid parental leave.
• Fully remote work flexibility within the United States, with offices in New York City and San Francisco for those who prefer in-person work.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: No Education Listed