Senior Director, RCM & Credentialing
Spring HealthSalary not specified
Full Time
Senior (5 to 8 years), Expert & Leadership (9+ years)
Not SpecifiedCompensation
Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level
Full TimeJob Type
UnknownVisa
Healthcare, Maternal HealthIndustries
Requirements
- 5+ years healthcare operations experience, ideally having worked within healthcare delivery or a high-growth startup
- 2+ years people management experience
- 1+ years experience managing licensing, credentialing, and enrollment activities
- Experience with credentialing APPs, therapists, registered dietitians, physicians, and doulas with Medicaid managed care plans preferred
- Exceptional project management and prioritization skills
- Experience building and scaling operational processes for clinicians
- Results-oriented operator who moves fast
- Meticulous attention to detail
- Comfort with ambiguity
- Exceptional ability to work cross-functionally with clinicians, technical teams, and external vendors / contacts
- Passionate about maternal and child health
Responsibilities
- Manage a team of licensing and credentialing associates and managers
- Oversee the end-to-end process for licensing, credentialing and enrolling providers with states and our health plan partners
- Own and implement licensing, credentialing, and enrollment strategy across clinical specialties, payers and geographic states to ensure adequate coverage and access to care for patients
- Leverage data to proactively identify gaps in both process and clinician licensing, credentialing, and enrollment coverage
- Proactively identify and resolve process improvements, both internally and with third parties
- Own processes related to the Pomelo Credentialing Committee
- Work cross-functionally with our customer success, market operations, and clinical teams to hit our licensing and credentialing goals
- Manage relationship with third-party licensing vendor, including holding them accountable to SLAs
- Lead audit activities related to licensing, credentialing, and enrollment including delegated credentialing agreements
- Scale the licensing, credentialing, and payer enrollment guide across all Pomelo states and payers
Skills
Key technologies and capabilities for this role
Questions & Answers
Common questions about this position
What experience is required for this Senior Manager role?
Candidates need 5+ years of healthcare operations experience, ideally in healthcare delivery or a high-growth startup, 2+ years of people management experience, and 1+ years managing licensing, credentialing, and enrollment activities. Experience with credentialing APPs, therapists, registered dietitians, physicians, and doulas with Medicaid managed care plans is preferred.
What are the main responsibilities of this position?
You will manage a team of licensing and credentialing associates and managers, oversee end-to-end processes for licensing, credentialing, and enrolling providers, own strategy across specialties and states, leverage data to identify gaps, and work cross-functionally to meet goals.
What is the compensation or salary for this role?
This information is not specified in the job description.
Is this position remote or does it require office work?
This information is not specified in the job description.
What makes a strong candidate for this role at Pomelo Care?
A strong candidate has exceptional project management skills, experience building and scaling processes for clinicians, is results-oriented with meticulous attention to detail, comfortable with ambiguity, and excels at cross-functional collaboration, plus passion for maternal and child health.
Pomelo Care
Personalized healthcare for pregnancy and newborns
About Pomelo Care
Pomelo Care provides personalized healthcare services for pregnant individuals and newborns. The company combines traditional medical practices with advanced technology to improve health outcomes for families. Their services are designed to be accessible and focus on evidence-based care, ensuring that expectant mothers and their newborns receive the best possible support. Unlike many competitors, Pomelo Care emphasizes a tailored approach to healthcare, integrating technology to enhance the patient experience. The goal of Pomelo Care is to create a supportive environment that promotes the health and well-being of families during pregnancy and early childhood.
New York City, New YorkHeadquarters
2021Year Founded
$84.6MTotal Funding
SERIES_BCompany Stage
HealthcareIndustries
11-50Employees
Benefits
Health Insurance
Company Equity
Paid Vacation
Risks
Competition from similar maternity care providers may reduce Pomelo's market share.
Operational challenges from integrating The Doula Network could affect service delivery.
Regulatory scrutiny on virtual healthcare may increase compliance costs for Pomelo.
Differentiation
Pomelo Care combines virtual and in-person maternity services, unique in the industry.
The acquisition of The Doula Network enhances Pomelo's comprehensive care model.
Pomelo uses data science to improve maternal and infant health outcomes.
Upsides
Increased demand for telehealth boosts Pomelo's virtual care services.
Expansion of Medicaid coverage offers Pomelo new market opportunities.
Growing interest in personalized healthcare aligns with Pomelo's service model.
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