Director, Payor OperationsZócalo Health • Los Angeles, California, United States
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Director, Payor Operations
Zócalo Health
- Los Angeles, California, United States
- Los Angeles, California, United States
Über
Founded in 2021, Zócalo Health is backed by leading healthcare and mission-aligned investors and is scaling rapidly across states and populations. We are building a durable care platform designed to perform in constrained healthcare environments and to lead the shift toward accountable, value-based care.
Role Description The Director of Payor Operations will join Zócalo Health during a period of increasing payer complexity and operational scale. This role exists to ensure payer requirements are clearly defined, consistently operationalized, and executed accurately across the organization. You will own the payer rulebook, translate requirements into workflows, and drive plan-level performance. This position reports to the Chief Operating Officer.
Payer Rulebook & Workflow Definition
Own and maintain a centralized payer rulebook across all health plans
Interpret payer requirements and translate them into clear operational workflows
Standardize workflows where possible while maintaining plan-specific requirements
Continuously update workflows as requirements evolve
Plan-Level Performance Ownership
Own performance outcomes at the health plan level (KPIs, compliance, documentation)
Monitor performance across geographies and identify gaps
Ensure consistency in workflow execution across teams
Hold internal teams accountable for plan-level performance issues
Diagnosis & Issue Resolution
Diagnose root cause of issues (execution vs workflow vs capacity vs quality)
Assign ownership and track resolution
Lead corrective actions for underperforming plans
Escalate systemic issues across plans
Team Leadership (Plan Owners & Trainer)
Manage L4 Plan Owners responsible for plan-level oversight
Define expectations for monitoring, escalation, and issue tracking
Oversee Payor Ops Trainer responsible for content development and rollout support
Ensure team operates with clarity and consistent ownership boundaries
Training Content & Change Enablement
Ensure payer requirements are translated into training-ready materials
Support rollout of workflow changes in partnership with CHW Workforce
Ensure plan-specific nuances are accurately captured
Validate that training content reflects current payer requirements
Qualifications
7–10+ years of experience in healthcare operations, payer operations, compliance, or related functions
Strong working knowledge of Medicaid managed care and payer-driven program requirements
Demonstrated experience interpreting payer or regulatory requirements and translating them into operational workflows
Experience managing multiple external stakeholders (health plans, partners) with differing requirements
Experience leading or supporting audit, QA, or compliance processes
Strong analytical skills with the ability to diagnose operational issues across execution, workflow, and capacity
Experience managing complex, cross-functional work without direct authority over execution teams
Preferred Qualifications
Experience working with CalAIM programs (ECM, Community Supports)
Experience working across multiple health plans simultaneously
Experience in high-growth or scaling organizations
What you can expect from Zócalo Health
Equity compensation package
Comprehensive benefits including medical, dental, and vision
401k
Flexible PTO policy – take the time you need to recharge
$1,000 home office stipend
We provide the equipment needed for this role
Opportunity for rapid career progression with plenty of room for personal growth.
You must be authorized to work in the United States. Remote Work can be done from anywhere in the U.S.
At Zócalo Health Inc., we see diversity and inclusion as a source of strength in transforming healthcare. We believe building trust and innovation are best achieved through diverse perspectives. To us, acceptance and respect are rooted in an understanding that people do not experience things in the same way, including our healthcare system. Individuals seeking employment at Zócalo Health are considered without regard to race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
Those seeking employment at Zócalo Health are considered without regard to race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
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Sprachkenntnisse
- English
Hinweis für Nutzer
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