Health Plans & Payers Recruiters

What health plan and payer roles do we recruit for?

We recruit physicians, nurses, and operators for health plans and payer groups. Common roles include medical director, Medicare Advantage and Medicaid managed care leader, Stars and HEDIS manager, risk adjustment leader, network director, and provider relations manager. These seats are non-clinical, but they still depend on clinical judgment and clear documentation.

We also recruit for quality, compliance, accreditation, case management, and finance-adjacent work. Some openings are narrow. Others combine review work, reporting, and leadership. We separate those pieces before outreach, so the people you meet match the actual job.

What does the workday look like in payer seats?

A workday may start with chart review, measure tracking, provider questions, or meeting prep. The person may move between calls with clinical staff, operations, compliance, and network teams. Some days are heavy on written decisions. Other days center on discussion, escalation, and follow-up.

We ask who owns which decision. A physician advisor may approve or deny within plan policy. A nurse may prepare reviews or manage queues. A quality leader may own reports, audit follow-up, and team coaching. That split matters when we present candidates to you.

Which backgrounds fit these openings best?

Strong candidates often come from managed care, case management, quality, provider relations, medical review, or revenue cycle. Some arrive from hospital systems and move into payer work. Others already know Medicare Advantage or Medicaid managed care and want broader responsibility. The right path depends on what your opening asks them to do.

We ask for examples, not broad titles. We want to hear about chart review, appeals, audit work, network conversations, vendor contact, and reporting. If the role needs physician judgment, we look for direct experience with that work. If it is operational, we keep the search there.

How do you define a vague opening before search begins?

Bring us the title, reporting line, and the problem you want solved. Tell us what changes after this hire starts. That might be cleaner review flow, stronger provider communication, better Stars follow-up, or steadier support for network work. We turn that into a practical search brief.

We also ask about the desk, the team, and the limits around the role. That includes schedule, work location, state licensure, and policy boundaries. If two people on the team own different parts of the work, we separate those parts before outreach.

What do we screen for before your interview?

We screen for real work history tied to your opening. We ask what systems they used, what reports they owned, what decisions they made, and where they escalated issues. We also check how they handled disagreement with providers, reviewers, or internal leaders.

If the role touches Stars, HEDIS, risk adjustment, or network work, we ask directly about that work. If it needs a physician or nurse, we check the setting and scope that matter to you. That keeps the shortlist grounded in the exact seat, not in a broad healthcare label.

How does the search move from intake to offer?

We start with intake and write the search around the work, not just the title. Then we reach out to people who are not applying on job boards. We speak with them directly, qualify their background, and send you a short list with a written brief on each person.

After interviews, we stay involved through the offer stage. We clarify scope, reporting, and next steps. If the search is confidential, we keep that boundary in place. We offer a candidate replacement guarantee on standard search agreements.

What else should you ask about this search?

Which related pages help you prepare?

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• Our Healthcare Headhunting Process
• Healthcare Recruiter Fees: No Upfront Fee
• Salary Guide Methodology (BLS BLS OEWS May 2025)