Director of Payor Operations

Job Summary

A company is looking for a Director of Payor Operations.

Key Responsibilities

• Own and maintain a centralized payer rulebook and translate payer requirements into operational workflows
• Monitor plan-level performance outcomes and ensure consistency in workflow execution across teams
• Manage team leadership, including Plan Owners and Trainers, to ensure clarity in expectations and issue tracking

Required Qualifications

• 7-10+ years of experience in healthcare operations, payer operations, or compliance
• Strong knowledge of Medicaid managed care and payer-driven program requirements
• Experience in interpreting payer or regulatory requirements into operational workflows
• Ability to manage multiple stakeholders with differing requirements
• Experience in leading audit, QA, or compliance processes