ZipRecruiter

Log In

Gaine Technology

2 jobs near Columbus, OH

SENIOR DIRECTOR HEALTHCARE SOLUTIONS

Gaine Technology LLC

San Luis Obispo, CA • Remote

$200K - $250K/yr

Full-time

Re-posted 27 days ago

Job description

Role Overview

The Senior Director of Healthcare Solutions is a senior, client-facing leader who serves as the authoritative bridge between our Health Data Management Platform and the Healthcare Payer and Provider organizations we serve. Reporting to the Chief Delivery Officer, this role uniquely fuses delivery excellence with business development instincts — driving adoption, deepening customer relationships, and ensuring our platform consistently delivers measurable value across health plans, integrated delivery networks, hospitals, medical groups, ACOs, and ancillary provider organizations.


This leader is a trusted advisor who engages with customers before, during, and after the sale. They bring the rare combination of healthcare industry acumen, technical process fluency, and executive-level communication to translate what Payer and Provider customers actually need (not just what they ask for) into delivery strategies that succeed in highly regulated, operationally complex environments. They lead cross-functional delivery teams and align internal stakeholders around customer timelines, expectations, and outcomes.


Key Responsibilities
  • Serve as the senior executive owner of Payer and Provider customer relationships from pre-sale through post-implementation, building trusted advisor credibility with C-level, VP-level, and operational leaders across business, clinical, and IT functions.
  • Translate stated customer requests into the underlying business outcomes the customer truly needs — reduced medical loss ratio, improved Star Ratings and HEDIS performance, accurate risk adjustment, faster claims adjudication, cleaner provider data, better care management workflows, or improved revenue cycle yield.
  • Lead delivery of complex Health Data Management engagements spanning claims, member/patient, provider, encounter, clinical, pharmacy, and lab data domains.
  • Proactively manage customer expectations and surface opportunities for the customer to optimize, expand, or modernize their use of the platform.
  • Collaborate heavily with the Sales and Business Development team to support new account growth and expansion within existing accounts — contributing to pursuit strategy, solution shaping, scoping, SOW development, and executive-level proposal defense.
  • Provide direct and matrixed leadership across the full delivery team structure, ensuring internal and external project participants operate in lockstep against shared milestones and quality bars.
  • Communicate clearly and credibly with internal audiences — Product, Engineering, Customer Success, Finance, and the Executive Team — on customer needs, timelines, escalations, and platform investment priorities.
  • Champion operational rigor: governance cadences, risk and issue management, financial stewardship, and outcome reporting tailored to Payer and Provider expectations.


Solution Architecture & Technology Integration

Healthcare Payer and Provider environments are defined by a long tail of legacy systems running alongside modern cloud platforms. This role requires fluency across both, with the ability to engage credibly on integration architecture for any customer landscape.


  • Demonstrated knowledge of both legacy and state-of-the-art integration patterns including batch file processing (X12 EDI, flat files, SFTP), real-time APIs (REST, SOAP, FHIR), enterprise Service Bus architectures, and modern event-driven patterns (Kafka, EventBridge, pub/sub).
  • Understanding of healthcare interoperability standards including HL7 v2, FHIR R4, C-CDA, USCDI, and X12 transaction sets (837, 835, 834, 270/271, 276/277, 278, 820).
  • Familiarity with core Payer administration platforms (e.g., Facets, QNXT, HealthRules, HealthEdge) and Provider clinical and revenue systems (e.g., Epic, Oracle Health/Cerner, Meditech, athenahealth, NextGen, Allscripts).
  • Working knowledge of ERP configuration and integration lifecycles — from requirements and design through configuration, integration testing, cutover, and steady-state — as they intersect with healthcare administrative, financial, and supply chain operations.
  • Understanding of enterprise data warehouses, lakehouses, and analytics platforms (e.g., Snowflake, Databricks, Azure Synapse, Health Catalyst, Epic Caboodle) and how they support population health, risk adjustment, quality reporting, and regulatory submissions.
  • Awareness of broader enterprise platform ecosystems commonly encountered in large-scale healthcare data projects, including identity and access management, MDM, data governance, master person index (EMPI), provider data management, and consent management solutions.
  • Ability to engage credibly with technical delivery leads, solution architects, and integration developers on architecture, data flows, and integration design — without needing to write the code.


Required Experience
  • 15+ years of progressive experience in healthcare technology, with demonstrated success as a senior leader in both delivery and client-facing leadership roles serving Payer and/or Provider organizations.
  • Demonstrated success operating at the intersection of delivery and business development — contributing directly to revenue growth, account expansion, or retention in a SaaS or enterprise software environment.
  • Experience leading and developing cross-functional delivery teams including project managers, business analysts, technical architects, integration developers, and data specialists.
  • Deep familiarity with the Payer and Provider data landscape: claims processing, eligibility and enrollment, prior authorization, care management, risk adjustment, quality measurement (HEDIS, Stars, MIPS), value-based care arrangements, provider data, EHR data, and revenue cycle.
  • Track record of managing executive-level customer relationships and navigating multi-stakeholder healthcare organizations through complex transformation.


Technical & Domain Knowledge
  • Strong working knowledge of Health Data Management concepts including data governance, data quality, MDM, EMPI, ETL/ELT, and data migration in healthcare contexts.
  • Fluency with healthcare regulatory and compliance frameworks: HIPAA, HITECH, 21st Century Cures Act, ONC interoperability and information blocking rules, CMS interoperability mandates, NCQA, URAC, and state-level Payer regulations.
  • Understanding of SaaS platform delivery models and the commercial and operational dynamics that drive customer success in a subscription environment.
  • Proficiency in business reporting, executive dashboards, and project status tooling (e.g., Jira, Salesforce, PowerPoint, Excel, Power BI or similar).


Leadership Competencies

Competency

What It Looks Like in This Role

Diagnostic Listening

Asks the questions that reveal what Payer and Provider customers truly need — not just what they’ve asked for.

Executive Communication

Delivers complex delivery, regulatory, and technical narratives with clarity and confidence to clinical, operational, and IT audiences.

Delivery Accountability

Holds teams to milestones with discipline and empathy, removing blockers decisively across matrixed healthcare organizations.

Commercial Acumen

Spots expansion signals within delivery relationships and converts them into qualified opportunities in partnership with Sales.

Change Navigation

Steers customers and internal teams calmly through scope changes, regulatory shifts, and organizational pivots.

Team Development

Coaches delivery team members to grow into stronger advisors and contributors within the healthcare domain.


Education & Optional Qualifications
  • Bachelor’s degree in Healthcare Administration, Health Informatics, Information Systems, Business, Nursing, Public Health, or a related field. Master’s degree or MBA is optional.
  • PMP, PgMP, or equivalent project/program management certification is a plus.
  • Certifications in healthcare data and compliance frameworks (e.g., CPHIMS, AHIP, CHC, HIPAA compliance, data governance) are advantageous.


Team Leadership Scope

This role provides direct or matrixed leadership to delivery team roles across Healthcare Payer and Provider customer engagements, including:


  • Project Sponsor (executive governance alignment)
  • Project Lead (end-to-end delivery execution)
  • Business Operations Lead (subject area SME — Claims, Member/Patient, Provider, Encounter, Clinical)
  • Technical Delivery Lead (data architecture & integration oversight)
  • Business Analyst (requirements, compliance, and UAT)
  • Integration Developer (API, ETL, EDI, and data pipeline delivery)
  • Testing Lead (data quality validation and migration testing)
  • Data Steward (data accuracy, exception management, governance)


The Senior Director of Healthcare Solutions is accountable for ensuring all eight delivery roles operate in a coordinated, high-performing manner across both internal and external project participants.