Payor Relations & Clinical Criteria Manager

Thank you for your interest in joining Solventum. Solventum is a new healthcare company with a long legacy of solving big challenges that improve lives and help healthcare professionals perform at their best. At Solventum, people are at the heart of every innovation we pursue. Guided by empathy, insight, and clinical intelligence, we collaborate with the best minds in healthcare to address our customers’ toughest challenges. While we continue updating the Solventum Careers Page and applicant materials, some documents may still reflect legacy branding. Please note that all listed roles are Solventum positions, and our Privacy Policy: https://www.solventum.com/en-us/home/legal/website-privacy-statement/applicant-privacy/ applies to any personal information you submit. As it was with 3M, at Solventum all qualified applicants will receive consideration for employment without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Job Description:

Payor Relations & Clinical Criteria Manager, Revenue Cycle Management | Solventum

3M Health Care is now Solventum

At Solventum, we enable better, smarter, safer healthcare to improve lives. As a new company with a long legacy of creating breakthrough solutions for our customers’ toughest challenges, we pioneer game-changing innovations at the intersection of health, material and data science that change patients' lives for the better while enabling healthcare professionals to perform at their best. Because people, and their wellbeing, are at the heart of every scientific advancement we pursue.

We partner closely with the brightest minds in healthcare to ensure that every solution we create melds the latest technology with compassion and empathy. Because at Solventum, we never stop solving for you.

The Impact You’ll Make in this Role

As a Payor Relations & Clinical Criteria Manager, you will have the opportunity to tap into your curiosity and collaborate with some of the most innovative and diverse people around the world. Here, you will make an impact by:

• Leading, developing, and mentoring a team responsible for monitoring, analyzing, and interpreting healthcare coverage criteria changes across Medicare, Medicaid, and Commercial payors.
• Defining and governing payor criteria and billing rules aligned to payor manuals, contracts, and payor behavior to support operational accuracy and future-state decision support capabilities.
• Developing and maintaining master data structures for payor billing rules, clinical coverage criteria, and medical necessity requirements to support consistent execution across the revenue cycle.
• Communicating and educating Homecare Operations and Billing & Collections teams on evolving coverage requirements, documentation expectations, and payor-specific billing rules.
• Driving revenue cycle performance by strengthening payor-related processes, resolving AR issues tied to payor system/process defects, and partnering cross-functionally with Managed Care Contracts, MCO Sales, Contracting, Operations, and Billing teams.

Your Skills and Expertise

To set you up for success in this role from day one, Solventum requires (at a minimum) the following qualifications:

• Bachelor’s degree or higher (completed and verified prior to start) from an accredited institution AND seven (7) years of experience in healthcare revenue cycle, payor policy, managed care, and/or billing criteria

OR

• High School Diploma/GED (completed and verified prior to start) from an accredited institution AND eleven (11) years of experience in healthcare revenue cycle, payor policy, managed care, and/or billing criteria

AND

In addition to the above requirements, the following are also required:

• Five (5) years of people leadership experience in revenue cycle, clinical documentation, and/or payor relations.
• Strong working knowledge of Medicare, Medicaid, and Commercial coverage criteria.
• Strong contract analysis and interpretation skills.
• Proven ability to analyze complex regulatory and coverage policy changes and translate them into operational guidance.
• Excellent communication skills with demonstrated ability to educate clinical, billing, and operational partners effectively.

Additional qualifications that could help you succeed even further in this role include:

• Experience in Homecare, DME, or post-acute care reimbursement.
• Lean, Six Sigma, or structured problem-solving training.
• Strong ability to influence without authority across large, matrixed organizations.

Work location: Hybrid in San Antonio, Texas

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