Director of Health Plan Operations

Summary

Join Cartwheel, a rapidly growing telehealth platform revolutionizing mental health care for schools, students, and families, as their Director of Health Plan Operations. You will lead payer strategy and compliance, manage a team responsible for payer enrollment, credentialing, and licensing, and collaborate with the Revenue Cycle team to build a high-performing function. This W2, full-time, remote position requires 7-10+ years of health plan operations experience, including group contracting, payer enrollment, and compliance. You will manage payer relationships, ensure compliance, oversee a team, maintain accurate records, and partner with other teams. Cartwheel offers competitive compensation, equity, excellent health insurance, paid time off, and other benefits.

Requirements

• Embodies our values: Human, Humble, Accountable, Innovative, Resilient
• Has 7-10+ years of health plan operations experience, including group contracting, payer enrollment and provider credentialing, and compliance
• Thrives in a world of rapid startup growth
• Achieves quality results quickly and prioritizes outcomes
• Uses data to drive decisions, and has a keen understanding of dashboards and metrics
• In the face of competing priorities, prioritizes and moves forward without getting stuck
• Seamlessly transitions between strategic thinking and hands-on operations
• Most importantly, you're ready to support our mission and drive core health plan operations functions that will help tens of thousands of students and families nationwide get the mental health care they need

Responsibilities

• Learn the ins and outs of Cartwheel’s processes, and start identifying process improvements in health plan operations
• Become proficient in the systems we use, including Apero, Healthie, the Cartwheel portal, Guru, Asana, Slack and Google Suite
• Start managing Cartwheel’s payer partnerships and processes
• Manage all payer relationships and contracting, including upfront contracting, ongoing contract negotiation, and appropriate escalation and resolution of issues
• Establish and oversee processes to ensure compliance with legal and regulatory requirements and build a culture of compliance in partnership with operations and clinical leadership
• Ensure Cartwheel is an in-network provider with all state Medicaid, MCO, and commercial payers in the states in which we operate and the states to which we plan to expand
• Oversee a team responsible for payer enrollment, provider credentialing, and provider licensing, ensuring strong performance
• Maintain accurate records of Cartwheel’s network status with payers and individual clinicians’ credentialing status
• Partner effectively with RCM team to achieve key performance metrics including reimbursement rates and collections rate
• Collaborate with teams across Cartwheel including Business Operations, Care Operations, Clinical Operations, People & Culture, and Technology
• Continually evaluate health plan operations processes and implement improvements for efficient scale as Cartwheel grows

Preferred Qualifications

Strong preference for experience with virtual / telehealth mental and behavioral health services

Benefits

• Competitive cash compensation between $130,000-160,000, based on experience
• Equity ownership stake in the company
• High-quality health insurance with a $0 monthly premium option for employees
• Dental, Vision, and Employer-Sponsored Life Insurance
• 4 weeks of paid PTO (3 weeks any time + 1 week office closure in December)
• Sick Leave + Holidays
• 401K with up to 2% employer match
• $500 annual educational stipend
• Team-based culture with mission-driven colleagues who will go to bat for you