OpenLoop
White-label telehealth platform and services
Manager, Payer Contracting - Clinical Compliance
About the job
- A bachelor's degree or equivalent relevant experience.
- At least 6 years of progressive experience in payer, managed care, or provider contracting, ideally within a multi-state or national healthcare organization.
- Significant provider-side payer contract negotiation experience, including direct responsibility for negotiating contract terms and reimbursement with payer representatives.
- Experience managing contracts across multiple payers, entities, markets, or states.
- Strong understanding of group versus individual provider contracting, including the related operational and enrollment considerations.
- Deep understanding of healthcare reimbursement methodologies, provider contracting, fee schedules, claims reimbursement, and managed care contracting.
- Experience evaluating financial and operational data to prepare for and support payer negotiations.
- Working knowledge of Medicare, Medicaid, Medicaid Managed Care Organizations, Medicare Advantage, and commercial payer contracting.
- Experience partnering with Revenue Cycle Management, Payer Enrollment, Finance, Coding, Clinical Operations, and other stakeholders to operationalize payer agreements.
- Ability to independently structure incomplete or fragmented information, identify gaps, develop a path forward, and drive work through completion.
- Ability to manage multiple complex priorities and sensitive deadlines with a high degree of autonomy.
- Own the payer contracting portfolio, including identifying, organizing, assessing, negotiating, implementing, renewing, and managing payer contracts.
- Build an inventory and contracting map across entities, including agreements, contracting entities, payer relationships, state requirements, renewal dates, fee schedules, and remediation gaps.
- Determine contracting strategies for group-level and individual provider contracts across entities, provider groups, markets, and states.
- Lead payer negotiations and renegotiations as the primary contracting representative with national and regional health plans.
- Negotiate reimbursement rates, fee schedules, contract terms, and other financial arrangements.
- Use utilization, reimbursement, coding, payer mix, and financial data to develop negotiation strategies and represent the organization in negotiations.
- Partner with Revenue Cycle Management and coding stakeholders to understand billed services and codes, identify contracting implications, and align agreements with the care delivery model.
- Collaborate with Payer Enrollment to align contracted entities, providers, state identifiers, and enrollment requirements with payer agreements.
- Coordinate with Revenue Cycle Management, Finance, Clinical Operations, Compliance, and other stakeholders to implement negotiated contracts accurately in downstream systems and workflows.
- Evaluate contracts for opportunities to consolidate, restructure, renegotiate, or transition agreements as organizational structure and payer strategy evolve.
- Support integration of acquired or newly added businesses into the payer contracting strategy by assessing payer relationships and determining the future-state contracting approach.
- Maintain current knowledge of Medicare, Medicaid and Medicaid Managed Care, Medicare Advantage, and commercial reimbursement methodologies and contracting requirements.
- Monitor contract performance, renewals, reimbursement changes, and payer-specific issues, and initiate renegotiations or corrective actions when needed.
- Maintain relationships with payer contracting representatives and resolve escalated contract-related issues.
- Serve as the subject matter expert for payer contracting and establish scalable contracting processes, documentation, and operating standards.
- Lead payer contracting projects independently, align stakeholders, and drive decisions through implementation.
- Perform other duties as assigned.
- Experience working within both a payer and provider organization, with an understanding of the impact of contracting decisions on each side.
- Experience leading payer contracting for a national healthcare, telehealth, physician group, hospital, or other multi-state provider organization.
- Experience with value-based contracting or alternative reimbursement arrangements.
- Experience consolidating or restructuring payer agreements following acquisitions, entity changes, or organizational growth.
- Familiarity with provider enrollment and credentialing platforms such as MDStaff, Medallion, or Verisys.
- Familiarity with payer portals, healthcare billing systems, contract management tools, and workflow platforms such as Jira, Zendesk, or Zoho Desk.
About the company
OpenLoop Health provides white-label telehealth infrastructure that lets organizations launch or scale virtual care. Its platform includes a HIPAA-compliant toolkit—electronic health records, scheduling, payments, video visits, and API integrations—plus back-end services like regulatory setup and revenue-cycle management. It relies on a nationwide clinician network across all 50 states to staff and credential care, enabling partners to keep their own brand. Its goal is to make virtual care accessible to organizations of any size by delivering end-to-end virtual care through combined technology, staffing, and operations support.
Company Size
501-1,000
Company Stage
Series A
Total Funding
$26.2M
Headquarters
Des Moines, Iowa
Founded
2020
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Simplify's Take
What believers are saying
- August 12, 2026 OpenLoop hired Sara Crate to expand employer, payer, and hospital sales.
- April 2026 Season Health and June 2026 Hey Revia broadened chronic-care and automation capabilities.
- OpenLoop's higher-acuity nutrition, sleep, and remote-monitoring programs deepen wallet share with existing clients.
What critics are saying
- February 16, 2026 class-action litigation targets OpenLoop after the January 2026 data breach.
- BBB lists 304 complaints over three years, signaling recurring customer and operational friction.
- January 30, 2026 Medicare telehealth flexibilities expired, squeezing OpenLoop's reimbursement-dependent virtual-care model.
What makes OpenLoop unique
- OpenLoop powers 300-plus organizations with brandable telehealth infrastructure and clinicians nationwide.
- June 30, 2026 Hey Revia added AI communications across intake, authorization, and patient outreach.
- OpenLoop combines technology, provider-of-record services, and billing operations across employer, payer, and health-system programs.
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Benefits
Health Insurance
Dental Insurance
Vision Insurance
Life Insurance
Flexible Work Hours
Unlimited Paid Time Off
401(k) Retirement Plan
401(k) Company Match
Flexible Spending/Health Savings Account
Pet Insurance
Growth & Insights and Company News
6 month growth
↑ 0%1 year growth
↑ 0%2 year growth
↑ 0%OpenLoop, a telehealth infrastructure platform serving over 300 organisations, has announced a shift in expansion strategy, opting for strategic investments rather than outright acquisitions. The company has invested in Happy Sleep, which makes an FDA-cleared smart ring that diagnoses sleep apnea at home in five days with 98% accuracy. Since 2024, OpenLoop has completed 13 strategic investments and acquisitions, including Season Health and Hey Revia. The investment approach allows the company to support operators in categories where it already runs clinical operations — such as sleep, weight management, and nutrition — without the integration burden of full acquisitions. OpenLoop has operated Happy Sleep's clinical diagnostics, including provider review, since April 2026. The company plans to pursue additional equity investments in consumer healthcare companies this year.
Brightn, an AI-powered mental wellness platform, has partnered with OpenLoop Health to offer integrated mental health support combining daily AI-driven check-ins with on-demand access to licensed therapists. Users can now move from journaling and mood tracking to sessions with credentialed clinicians without leaving the app. The partnership addresses a gap in behavioral health care, where traditional support occurs only during scheduled appointments. Brightn provides daily emotional tracking informed by clinical psychologist Dr Ahmed Darwish, whilst OpenLoop supplies nationwide access to master's-level therapists across all 50 US states. A pilot study at Worcester Polytechnic Institute showed participants reported a 36.1% reduction in depression symptoms and 15.3% decrease in anxiety. In a six-month employer deployment, 15% of eligible employees enrolled — significantly higher than typical employee assistance programme utilisation rates. The platform includes crisis detection features that route users to resources including the 988 Suicide and Crisis Lifeline when acute distress is identified.
Happy Health snags $75M to support home-based care. Happy Health's $75 million round was from ARCH Venture Partners and OpenLoop. Happy Health, a health platform for at-home monitoring, announced Tuesday that it raised $75 million to support the transition to home-based care. The Texas-based company offers an FDA-cleared smart ring for at-home diagnosis of obstructive sleep apnea. It also provides treatment management and daily sleep health measurements. Happy Health's platform uses continuous health data and AI to create a personalized baseline for each patient, helping doctors identify meaningful changes in their health. Sleep is the company's first focus area, but it plans to expand into other areas in the future. "Our bigger vision is precision diagnostics that live on your finger and enable care across many conditions from the comfort of patients' home," said Dr. Dustin Freckleton, founder and CEO of Happy Health. presented by What if health plans could identify member decline before an avoidable hospitalization occurs? Real-time clinical visibility into long-stay SNF members uncovers risk earlier and drives better outcomes. The $75 million round was from ARCH Venture Partners and OpenLoop. The financing will help Happy Health accelerate the clinical validation of its tech, as well as build the infrastructure to expand beyond sleep, Freckleton told MedCity News. Happy Health is supporting the shift toward more proactive care, according to ARCH Venture Partners. "For decades, healthcare has waited until people are already sick to act," said Paul Berns of ARCH Venture Partners in a statement. "Happy Health is showing that many diagnoses may never need to happen inside a hospital at all. By combining continuous physiological monitoring with physician-guided care, they're proving what care can look like when it moves into the home." Currently, the healthcare system is organized around episodic visits, often discovering chronic diseases too late, according to Freckleton. Sleep apnea is an example of this. presented by In an interview, Kyan Health Co-Founder and Chief Commercial Officer Konstantin Struck discussed how Kyan gives mid-market and enterprise employers access to premium workforce mental healthcare, at a price point that is affordable. "It's a pervasive health disorder that amplifies nearly every serious downstream condition: cardiovascular disease, stroke, AFib, all-cause mortality," he said. "There's one sleep doctor for every 43,000 Americans, and a 3-4 month wait to get into a clinic. So 80% of people who have it don't know it. There are many treatment options available for sleep apnea, which will in turn mitigate development of other chronic conditions, but you can't get care if you aren't diagnosed." Freckleton has experienced these issues firsthand. He had a stroke at the age of 24 and didn't receive a diagnosis for sleep apnea for another seven years, despite it being a common stroke risk factor. Happy Health isn't the only company offering a wearable ring that tracks sleep. Oura also offers a ring that provides users with insights into their sleep and other health metrics, but unlike Happy Health's ring, Oura's is not a medical device and is not intended to diagnose medical conditions. Ultimately, Happy Health aims to "enable continuous monitoring at home so we can detect disease earlier and give physicians the opportunity to intervene before conditions become more serious," Freckleton said.
Happy Health, an Austin-based digital health company, secured $75 million in Series A funding led by ARCH Venture Partners and OpenLoop to expand its AI-powered home care platform. The startup's FDA-cleared Happy Ring is the first smart ring approved for multi-night sleep testing and continuous biometrics. It diagnoses obstructive sleep apnea and insomnia in as few as three nights with 98% accuracy, according to the company. The platform collects over 2.8 million biometric measurements nightly, building individualised physiological baselines rather than comparing patients to population averages. Happy Sleep includes board-certified sleep physicians and accepts most major insurance plans, including Blue Cross and Medicare. The company plans to extend its continuous monitoring approach to cardiovascular, metabolic, and other chronic diseases.
OpenLoop expands its platform to widen access to medically necessary care. The company names Sara Crate as General Manager of Health Systems and Employer to lead growth across employer, payer, and hospital channels. DES MOINES, IA, UNITED STATES, August 12, 2026 /EINPresswire.com/ - OpenLoop, the leading infrastructure telehealth platform powering more than 300 organizations nationwide, today announced a broad expansion of the programs it runs for employers, payers, and health systems, extending its infrastructure into higher-acuity care for patients managing complex conditions. The expansion builds on the medically necessary care programs OpenLoop already runs for employers, payers, and health systems. OpenLoop is expanding programming and partnerships across four growth areas: - Medical nutrition therapy for complex populations, including patients managing pregestational diabetes, congestive heart failure, and recovery from bariatric surgery - Employer health benefits, moving upstream into the large self-insured employer and ASO market - Hospital and health system programs spanning post-discharge transitions, disease management, and remote patient monitoring - Provider-of-record support for digital health, DME, and pharmacy partners that need a clinical partner to enroll and manage patients Demand from employers and payers already running these programs prompted the decision to invest in a dedicated team and bring in leadership to run it. "For years, our medical nutrition therapy and chronic disease management programs have helped patients get the ongoing, coordinated care that complex conditions require," said Jon Lensing, Co-Founder and CEO of OpenLoop. "The demand continues growing, so we built a team around it. The companies that reach patients with complex conditions over the next few years will be the ones that can already enroll them, confirm the care they need, and handle the billing without assembling all of it from scratch." "At 1 True Health, every partnership we form is evaluated based on one question: Will it help us deliver a better healthcare experience? OpenLoop stood out because of its nationwide reach, operational excellence, and ability to scale alongside our growth without compromising quality. Their experienced provider network and proven infrastructure make them an outstanding partner as we continue expanding our care delivery capabilities and helping more organizations deliver high-quality care," said Shawn Smith, Chief Executive Officer of 1 True Health. To lead the expansion, OpenLoop has hired Sara Crate as General Manager of Health Systems and Employer. Across these areas, OpenLoop operates as the layer that enrolls patients, acts as provider of record, and runs the back-office billing, so employers, hospitals, and health companies can offer clinical programs without standing up their own provider groups or reimbursement operations. Crate was most recently CEO of Homebase Medical, delivering in-home and virtual care to high-needs seniors. She brings more than 25 years in healthcare, with commercial leadership roles held at DispatchHealth, Honor, Evolent Health, and Walgreens spanning the provider, payer, and in-home care markets. "I've spent my entire career working to get people the care they actually need, and the hardest part is almost always the infrastructure behind it, like reaching the patient, enrolling them, being the provider of record, and handling the billing," said Crate. "OpenLoop already built that, which is what pulled me in. It means we can walk into an employer, a payer, or a health system and start supporting their members' health from day one, even the most complex patients." Crate plans to hire dedicated leads for large self-insured employers, hospitals and health systems, digital health partnerships, and payer contracting. Open roles are posted at https://openloophealth.com/careers. Together, these programs advance OpenLoop's goal of building a single infrastructure that gives patients reliable access to the care their conditions require, in place of the fragmented point solutions that have long defined the market. About OpenLoop OpenLoop is a provider of virtual care operations, powering 300+ organizations to deliver scalable care solutions. By offering end-to-end infrastructure like clinicians, technology, and clinical compliance, companies can launch a fully operational telehealth program on demand, under their brand. OpenLoop has been recognized on TIME's Top HealthTech Companies (2025). Learn more at https://openloophealth.com/ Kamila Khasanova On Top Strategy [email protected] Legal Disclaimer: EIN Presswire provides this news content "as is" without warranty of any kind. We do not accept any responsibility or liability for the accuracy, content, images, videos, licenses, completeness, legality, or reliability of the information contained in this article. If you have any complaints or copyright issues related to this article, kindly contact the author above.