Manager, Payer Enrollments

Pomelo Care; United States; Remote; USD 95,000 - 115,000; Full time

Benefits offered by this job

Fully remote work flexibility (within

Offices in NYC and SF for in-person

Job summary

Pomelo Care, the leading virtual medical practice for women and children, seeks a results-driven leader to own payer enrollments across new and existing markets within our midlife program and to oversee licensing for midlife providers.

Reporting to the Director, Operations and Clinical Quality, you will manage a team of licensing and credentialing specialists, partner with payers, and drive enrollment strategy across clinical specialties and states.

Qualifications

• 3+ years experience enrolling APPs, therapists, dietitians, physicians, or doulas with payers.
• 2+ years healthcare operations experience, ideally in delivery or high-growth startup.
• 2+ years people management experience.
• 1+ years experience managing licensing, credentialing, and enrollment activities.
• Exceptional project management and prioritization skills.
• Results-oriented operator who moves fast.
• Meticulous attention to detail.
• Comfort with ambiguity.
• Ability to work cross-functionally with clinicians, tech teams, and external vendors.
• Passionate about women's health.

Responsibilities

• Manage a team of licensing and credentialing specialists with end-to-end licensing and enrollment across states and health plan partners.
• Own enrollment strategy across clinical specialties, payers and geographic states to ensure adequate coverage and access.
• Leverage data to identify gaps in process and clinician enrollment coverage.
• Identify and implement process improvements, including with third parties.
• Work cross-functionally with customer success, market operations, and clinical teams to hit enrollment goals.
• Manage relationship with third-party licensing vendor, including SLAs.
• Lead audit activities related to midlife licensing, credentialing, and enrollment including delegated credentialing.

Skills

Payer enrollment

Healthcare operations

People management

Licensing & credentialing

Cross-functional collaboration

Data-driven decisions

Job description

Pomelo Care is the leading virtual medical practice for women and children, providing care across pregnancy, postpartum, pediatrics, menopause, and perimenopause. We combine proactive, 24/7 clinical care with technology that helps us reach patients earlier, identify risks sooner, and deliver personalized care throughout their journey. Our team includes clinicians, technologists, operators, and problem-solvers working together to make high-quality care more accessible for families nationwide.

About the Role

Your North Star: Substantially contribute to the strategy of, and own the execution of, our payer enrollments across new and existing markets within our midlife (perimenopause and menopause) program. Own the execution of licensing for midlife providers.

Reporting to the Director, Operations and Clinical Quality, you will have the following responsibilities:

What You'll Do

• Manage a team of licensing and credentialing specialists. Oversee the end-to-end process for licensing, credentialing and enrolling providers with states and our health plan partners within our midlife offering.
• In partnership with the Director, Operations and Clinical Quality, own the enrollment strategy across clinical specialties, payers and geographic states to ensure adequate coverage and access to care for midlife patients
• Leverage data to proactively identify gaps in both process and clinician enrollment coverage
• Proactively identify and implement process improvements, both internally and with third parties
• Work cross-functionally with our customer success, market operations, and clinical teams to hit our enrollment goals
• Manage relationship with third-party licensing vendor, including holding them accountable to SLAs
• Lead audit activities related to midlife licensing, credentialing, and enrollment including delegated credentialing agreements

Who You Are

• 3+ years experience enrolling APPs, therapists, registered dietitians, physicians, and/or doulas with payers
• 2+ 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
• Exceptional project management and prioritization skills
• 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 women's health

Compensation

The expected base salary range offered for this role is $95,000-$115,000. This role is also eligible for equity, giving you an ownership stake in Pomelo's mission. Actual compensation may vary based on relevant experience, skills, competencies, and certifications.

Benefits and Perks

By joining Pomelo, you’ll get in on the ground floor of a fast-moving, well-funded startup on a mission to improve outcomes for all mothers and babies. We cultivate a collaborative, patient-first environment where data drives our decisions and team members are challenged to learn, grow, and have fun together. We also offer:

• 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 paid parental leave
• Fully remote work flexibility (within the US) with offices in NYC and SF for those who prefer in-person work

We are committed to hiring the best team to improve outcomes for all mothers and babies. To solve the complex challenges facing the diverse population we serve, we need diverse perspectives, actively welcoming people of all races, ages, sexual orientations, gender identities and expressions, national origins, religions, disabilities, and veteran statuses. We strive to cultivate an inclusive and respectful environment where team members thrive by working across disciplines, moving fast, making data driven decisions, learning continuously, and always putting the patient first.