Senior Manager, Licensing, Credentialing, & Enrollments

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.

Must Have

• 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 health plan partners
• Own and implement licensing, credentialing, and enrollment strategy across clinical specialties, payers and geographic states
• Leverage data to proactively identify gaps in both process and clinician coverage
• Proactively identify and resolve process improvements, both internally and with third parties
• Own processes related to the Pomelo Credentialing Committee
• Work cross-functionally with customer success, market operations, and clinical teams to hit goals
• Manage relationship with third-party licensing vendor, including holding them accountable to SLAs
• Lead audit activities related to licensing, credentialing, and enrollment including delegated credentialing agreements
• Scale the licensing, credentialing, and payer enrollment guide across all Pomelo states and payers
• 5+ years healthcare operations experience
• 2+ years people management experience
• 1+ years experience managing licensing, credentialing, and enrollment activities
• Exceptional project management and prioritization skills
• Experience building and scaling operational processes for clinicians
• 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 maternal and child health

Good to Have

• Experience with credentialing APPs, therapists, registered dietitians, physicians, and doulas with Medicaid managed care plans

Perks & Benefits

• Competitive healthcare benefits
• Generous equity compensation
• Unlimited vacation
• Membership in the First Round Network

Role Description

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:

What You’ll Do

• 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
• 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
• Leverage data to proactively identify gaps in both process and clinician licensing, credentialing, and enrollment coverage
• Proactively identify and resolve process improvements, both internally and with third parties
• Own processes related to the Pomelo Credentialing Committee
• Work cross-functionally with our customer success, market operations, and clinical teams to hit our licensing and credentialing goals
• Manage relationship with third-party licensing vendor, including holding them accountable to SLAs
• Lead audit activities related to licensing, credentialing, and enrollment including delegated credentialing agreements
• Scale the licensing, credentialing, and payer enrollment guide across all Pomelo states and payers

Who you are

• 5+ 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
• Experience with credentialing APPs, therapists, registered dietitians, physicians, and doulas with Medicaid managed care plans preferred
• Exceptional project management and prioritization skills
• Experience building and scaling operational processes for clinicians
• 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 maternal and child health

Why you should join our team

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:

• Competitive healthcare benefits
• Generous equity compensation
• Unlimited vacation
• 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)

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.

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