Senior Manager, Payer Implementation

This is a fully remote position, open to applicants in District of Columbia, +3 more states.

📋 Description

• Take charge of the daily delivery of payer implementations from the late stages of contract discussions through to the go-live phase.

• Develop and manage project timelines, coordinate supporting workstreams, and drive resolution of open items.

• Evaluate ongoing implementations, pinpoint unresolved issues, and facilitate necessary decisions to progress.

• Establish and lead workstreams for payer implementation.

• Manage data exchange requirements, file specifications, test files, acceptance criteria, and pre-go-live validation processes.

• Monitor enrollment, eligibility, in-program, and exclusion rules, ensuring that written definitions are consistent.

• Conduct clinical design sessions, prepare pre-reads, manage follow-ups, and maintain decision logs.

• Oversee outreach and marketing approvals, manage consent and opt-out processes, and schedule outreach timing.

• Handle BAAs, data use agreements, and other payer contracts in collaboration with Legal.

• Facilitate payer vendor onboarding and compliance efforts, including security questionnaires, delegation assessments, training attestations, exclusion screenings, and oversight audits.

• Conduct launch readiness reviews and make go/no-go decisions, lead post-launch stabilization, and ensure handoff to account management.

• Act as Chamber’s implementation contact with payer partners, leading meetings and ensuring follow-through on action items.

• Identify risks and decisions, escalate obstacles, and safeguard launch timelines.

• Prepare project plans, presentation materials, meeting notes, decision logs, progress updates, and implementation reports.

• Collaborate with Clinical, Operations, Finance, Provider Operations, Legal, and other cross-functional teams.

• Develop and enhance Chamber’s payer implementation playbook and toolkit.

• Conduct lessons-learned reviews following launches and integrate improvements into the playbook.

⛳️ Requirements

• A minimum of 5 years of experience leading payer implementations, either as a vendor to health plans or within a plan onboarding vendors, which includes aligning data, compliance, legal, marketing, and clinical teams on the same timeline.

• Proven experience in building and managing a payer implementation plan when the scope and requirements were not fully defined.

• Ability to navigate ambiguity and operate in environments lacking established structures and processes.

• Experience managing multiple workstreams simultaneously, encompassing data, outreach, and clinical operations.

• Excellent written communication and documentation abilities, including the creation of clear and accurate payer-facing presentations, meeting summaries, and implementation materials.

• Experience in managing cross-functional relationships through influence rather than direct authority.

• Candidates must possess authorization to work in the United States without sponsorship.

• Experience in value-based care, health plan vendor oversight, or delegation requirements, particularly for Medicare Advantage, is a plus.

🏝️ Benefits

• Opportunity to work remotely, with a location based in the United States.

• Occasional travel to client sites.