Director, Payor Operations

Director, Payor Operations

Remote (Full Time) 

Compensation: $160,000-$165,000 

 

About Us 

Zócalo Health is a tech-enabled, community-oriented primary care organization serving people who have historically been underserved by the one-size-fits-all  healthcare system. We partner with health plans, providers, and community organizations to deliver culturally competent primary care, behavioral health, and social care.

Our model is built for populations with high medical and social complexity, where fragmented care drives poor outcomes and unnecessary cost. We combine local, community-based teams with virtual care and modern technology to deliver coordinated, whole-person care where members live and receive support.

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.

The Director, Payor Operations  will contribute in the following ways:

• 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 fo