Director, Member Status - Strategy & Operations

Location: Remote USA; remote work with onsite expectations multiple times per year.

Salary: $182,000–$216,000 per year

Company

hirify.global is a healthcare company improving the health and well-being of older Americans through an integrated care platform combining data, AI, clinical services, and member support.

What you will do

• Own end-to-end member status determinations, including issue detection, investigation, updates, quality checks, and follow-up actions.
• Build and mature monitored, auditable workflows for Medicare Secondary Payer, hospice, ESRD, county-based rates, and related CMS requirements.
• Define operational KPIs, dashboards, aging controls, escalation paths, and expected-versus-actual payment analyses.
• Use AI-enabled tools to improve signal detection, document review, investigation triage, and manual-review efficiency.
• Partner with Data Science, Engineering, Finance, Actuarial, Risk Adjustment, Compliance, and Legal on controls and platform improvements.
• Build, develop, and retain teams while managing internal groups, offshore partners, and external vendors.

Requirements

• Track record of turning complex operational problems into scalable business processes.
• Experience building operational controls and launching cross-functional initiatives from idea to implementation.
• Ability to interpret complex regulatory or technical guidance and translate it into determination criteria, evidence standards, and workflows.
• Strong data fluency, including specifying requirements, interrogating datasets, and challenging analytical results.
• High ethical standards and sound judgment when handling revenue, compliance, and accuracy risks.
• Leadership experience in ambiguous, fast-moving environments with ownership of standards, controls, and operational roadmaps.

Nice to have

• Experience managing multiple teams and vendors, including offshore partners.
• Medicare Advantage, D-SNP, integrated Medicare-Medicaid, state file reconciliation, or deeming administration experience.
• Experience with CMS program audits or comparable regulatory examinations.
• Strong organizational, communication, and leadership skills.

Culture & Benefits

• Employer-sponsored health, dental, and vision plans with low or no premium.
• Generous paid time off and parental leave.
• $100 monthly mobile or internet stipend.
• Stock options for all employees and a 401(k) program.
• Safe, supportive, diverse, and collaborative work environment.