Pomelo

Senior Manager, Licensing, Credentialing, & Enrollments

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Pomelo Care is transforming outcomes for pregnant people and babies with evidence-based pregnancy and newborn care. This role, Senior Manager, Licensing, Credentialing, & Enrollments, is crucial for owning the strategy and execution of provider licensing, credentialing, and Medicaid enrollments across new and existing markets. The manager will lead a team, ensure adequate coverage, identify process gaps, and collaborate cross-functionally to achieve goals, directly impacting patient access to care.

Provider Credentialing Specialist

<h3 class="text-xl md:text-2xl font-bold mt-8 mb-3 text-gray-800">Role Description</h3>Your North Star: Own the strategy and execution of our licensing, credentialing, and Medicaid enrollments across new and existing markets.Reporting to the Senior Manager, Operations and Clinical Quality, you will have the following responsibilities:<h3 class="text-xl md:text-2xl font-bold mt-8 mb-3 text-gray-800">What You’ll Do</h3><ul class="list-disc list-inside my-5 pl-5 space-y-2 text-gray-700"><li class="leading-relaxed">Manage a team of licensing and credentialing associates and managers Oversee the end-to-end process for licensing, credentialing and enrolling providers with states and our health plan partners</li><li class="leading-relaxed">Own and implement licensing, credentialing, and enrollment strategy across clinical specialties, payers and geographic states to ensure adequate coverage and access to care for patients</li><li class="leading-relaxed">Leverage data to proactively identify gaps in both process and clinician licensing, credentialing, and enrollment coverage</li><li class="leading-relaxed">Proactively identify and resolve process improvements, both internally and with third parties</li><li class="leading-relaxed">Own processes related to the Pomelo Credentialing Committee</li><li class="leading-relaxed">Work cross-functionally with our customer success, market operations, and clinical teams to hit our licensing and credentialing goals</li><li class="leading-relaxed">Manage relationship with third-party licensing vendor, including holding them accountable to SLAs</li><li class="leading-relaxed">Lead audit activities related to licensing, credentialing, and enrollment including delegated credentialing agreements</li><li class="leading-relaxed">Scale the licensing, credentialing, and payer enrollment guide across all Pomelo states and payers</li></ul><h3 class="text-xl md:text-2xl font-bold mt-8 mb-3 text-gray-800">Who you are</h3><ul class="list-disc list-inside my-5 pl-5 space-y-2 text-gray-700"><li class="leading-relaxed">5+ years healthcare operations experience, ideally having worked within healthcare delivery or a high-growth startup</li><li class="leading-relaxed">2+ years people management experience</li><li class="leading-relaxed">1+ years experience managing licensing, credentialing, and enrollment activities</li><li class="leading-relaxed">Experience with credentialing APPs, therapists, registered dietitians, physicians, and doulas with Medicaid managed care plans preferred</li><li class="leading-relaxed">Exceptional project management and prioritization skills</li><li class="leading-relaxed">Experience building and scaling operational processes for clinicians</li><li class="leading-relaxed">Results-oriented operator who moves fast</li><li class="leading-relaxed">Meticulous attention to detail</li><li class="leading-relaxed">Comfort with ambiguity</li><li class="leading-relaxed">Exceptional ability to work cross-functionally with clinicians, technical teams, and external vendors / contacts</li><li class="leading-relaxed">Passionate about maternal and child health</li></ul><h3 class="text-xl md:text-2xl font-bold mt-8 mb-3 text-gray-800">Why you should join our team</h3>By joining Pomelo, you will get in on the ground floor of a fast-moving, well-funded, and mission-driven startup where you will have a profound impact on the patients we serve. And you'll learn, grow, be challenged, and have fun with your team while doing it.We strive to create an environment where employees from all backgrounds are respected. We value working across disciplines, moving fast, data-driven decision making, learning, and always putting the patient first. We also offer:<ul class="list-disc list-inside my-5 pl-5 space-y-2 text-gray-700"><li class="leading-relaxed">Competitive healthcare benefits</li><li class="leading-relaxed">Generous equity compensation</li><li class="leading-relaxed">Unlimited vacation</li><li class="leading-relaxed">Membership in the First Round Network (a curated and confidential community with events, guides, thousands of Q&A questions, and opportunities for 1-1 mentorship)</li></ul>At Pomelo, we are committed to hiring the best team to improve outcomes for all mothers and babies, regardless of their background. We need diverse perspectives to reflect the diversity of problems we face and the population we serve. We look to hire people from a variety of backgrounds, including but not limited to race, age, sexual orientation, gender identity and expression, national origin, religion, disability, and veteran status.Our salary ranges are based on paying competitively for our company’s size and industry, and are one part of the total compensation package that also includes equity, benefits, and other opportunities at Pomelo Care. In accordance with New York City, Colorado, California, and other applicable laws, Pomelo Care is required to provide a reasonable estimate of the compensation range for this role. Individual pay decisions are ultimately based on a number of factors, including qualifications for the role, experience level, skillset, geography, and balancing internal equity. A reasonable estimate of the current salary range is $145,000 to $170,000. We expect most candidates to fall in the middle of the range. We also believe that your personal needs and preferences should be taken into consideration, so we allow some choice between equity and cash.#LI-Remote

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<h3 class="text-xl md:text-2xl font-bold mt-8 mb-3 text-gray-800">About Springer Nature Group</h3>Springer Nature opens the doors to discovery for researchers, educators, clinicians and other professionals. Every day, around the globe, our imprints, books, journals, platforms and technology solutions reach millions of people. For over 180 years our brands and imprints have been a trusted source of knowledge to these communities and today, more than ever, we see it as our responsibility to ensure that fundamental knowledge can be found, verified, understood and used by our communities – enabling them to improve outcomes, make progress, and benefit the generations that follow. Visit http://group.springernature.com/ and follow @SpringerNature / @SpringerNatureGroup.Associate Editors, primarily focused on manuscript management, play a key role in advancing the manuscript pipeline for all BMC Series. Their responsibilities include evaluating manuscripts for compliance with editorial guidelines, selecting and inviting suitable peer reviewers, and making informed editorial decisions on submissions.<h3 class="text-xl md:text-2xl font-bold mt-8 mb-3 text-gray-800">About the Brand</h3>As an Associate Editor, you will play a crucial role in the success of the BMC Series by supporting the editorial management of content across a diverse portfolio of journals. This dynamic and varied position offers the opportunity to engage with a wide range of topics while contributing to the overall growth and success of BMC as a whole.Effective time management is a key aspect of this role, as you will be responsible for handling multiple tasks and deadlines simultaneously. From managing the peer review process to making editorial decisions, you'll need to prioritize efficiently and ensure timely progress on manuscripts. Your ability to stay organized and maintain a steady workflow will be crucial to supporting the smooth operation of the BMC Series portfolio and delivering high-quality content.<h3 class="text-xl md:text-2xl font-bold mt-8 mb-3 text-gray-800">Role Responsibilities:</h3><ul class="list-disc list-inside my-5 pl-5 space-y-2 text-gray-700"><li class="leading-relaxed">Assessing manuscripts for adherence to our editorial policies and suitability for peer review, resolving concerns with authors as and when required</li><li class="leading-relaxed">Identify and invite appropriate peer reviewers and manage the peer review process in a timely manner</li><li class="leading-relaxed">Make editorial decisions in accordance with BMC Series peer-review policies and standards.</li><li class="leading-relaxed">Coordinate with internal editorial teams to progress manuscripts through our manuscript submission system.</li><li class="leading-relaxed">Address manuscript challenges as they arise, in consultation with their manager and the Journal Editor when needed.</li></ul>Additional tasks:<ul class="list-disc list-inside my-5 pl-5 space-y-2 text-gray-700"><li class="leading-relaxed">Participate in outreach activities within the research community to promote the Series and encourage submission of manuscripts</li><li class="leading-relaxed">Support content promotion activities via BMC Series social media and blog networks</li><li class="leading-relaxed">Participate in working groups and projects to support research integrity and ongoing improvements in editorial processes, peer review standards, and journal quality.</li></ul><h3 class="text-xl md:text-2xl font-bold mt-8 mb-3 text-gray-800">Experience, Skills & Qualifications:</h3><ul class="list-disc list-inside my-5 pl-5 space-y-2 text-gray-700"><li class="leading-relaxed">Educated to PhD level (or equivalent), in a biomedical field</li><li class="leading-relaxed">In-depth knowledge of key areas of the BMC Series editorial policies</li><li class="leading-relaxed">Strong interpersonal communication skills</li><li class="leading-relaxed">Excellent written and verbal communication skills in English.</li><li class="leading-relaxed">Excellent organizational ability and time-management skills</li><li class="leading-relaxed">Highly self-motivated, resourceful and achievement oriented</li><li class="leading-relaxed">Strong analytical/critical appraisal skills</li><li class="leading-relaxed">Ability to work cooperatively with colleagues at all levels and as part of a team</li><li class="leading-relaxed">Ability to adapt to changing circumstances</li><li class="leading-relaxed">Willing to travel occasionally and represent BMC at external events</li></ul><h3 class="text-xl md:text-2xl font-bold mt-8 mb-3 text-gray-800">Need to be capable of:</h3>1. Technical CapabilityUses technical/job knowledge and experience to meet and exceed job requirements. Efficiently manages workload and projects within set timelines, achieving set objectives.2. Relationship Building/Teamwork (incorporating Communication, Influencing and Trust)Builds effective relationships through positive communication that motivates and influences others. Honest and trustworthy; a valued team member, actively involved in achieving team objectives. Works cooperatively and flexibly with other members of the team.3. Problem SolvingTakes initiative to identify current and potential problems and determines the best solution. Identifies the cause of problems and key issues through investigation; identifies effective, logical and practical solutions.4. Personal Effectiveness (incorporating results focused, productivity, ownership, delegation)To be considered for the role, Candidates should submit a cover letter in addition to their Resume when applying.In accordance with our internal career movement guidance, 12 months in current role is a requirement before applying to a new role.

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