Payer Systems & Integration Architect

At MCG, we lead the healthcare community to deliver patient-focused care. We have a mission-driven team of talented physicians and technical experts developing our evidence-based content and innovating our products to accelerate improvements in healthcare. If you are driven to enhance the US healthcare system, MCG is eager to have you join our team. We cultivate a work environment that nurtures personal and professional growth, and this is a thrilling time to become a part of our organization. With dynamic roles that offer meaningful impact, you'll be able to fully realize your potential. Plus, you'll enjoy world-class benefits and the security, stability, and resources of our parent company, Hearst, with over 100 years of experience. The Payer Systems & Integration Architect serves as MCG’s principal subject matter expert in payer-side healthcare workflows, system integrations, and data flows, providing strategic advisory guidance during customer implementations and complex solution design efforts. This role partners closely with Implementation, Product, Engineering, and customer stakeholders to address highly complex workflow and integration challenges, define scalable approaches, and guide implementation strategies within diverse payer environments. Operating with a high degree of independence, this individual applies deep expertise in health plan operations, interoperability, and system interactions to identify risks, resolve ambiguity, and improve implementation effectiveness across customer engagements. The role is also responsible for helping establish and mature this emerging capability at MCG by developing repeatable frameworks, standards, best practices, and reusable implementation approaches that strengthen organizational scalability and reduce dependency on limited subject matter expertise. You Will: • Serve as MCG’s principal subject matter expert and escalation authority for payer workflows, interoperability, integration architecture, and healthcare data flows across customer implementations and internal initiatives. • Lead complex workflow discovery and implementation advisory engagements to define integration strategies, clarify operational requirements, and guide solution design within diverse payer environments. • Advise implementation teams and customers on how MCG solutions integrate into complex payer operational and technical ecosystems, including utilization management workflows such as prior authorization . • Identify and resolve highly complex workflow, interoperability, and integration risks, gaps, dependencies, and implementation challenges, recommending scalable mitigation strategies and alternative approaches where standard solutions are insufficient. • Partner cross- functionally with Product, Engineering, Implementation, Sales, and customer stakeholders to align solution design, integration strategy, technical dependencies, and implementation execution. • Translate complex operational and technical concepts into clear, actionable guidance for technical teams, business stakeholders, and customers. • Facilitate working sessions with internal teams and customers to align on workflows, integration points, data dependencies, interoperability considerations, and implementation approaches. • Establish and evolve scalable implementation frameworks, standards, reusable assets, workflow models, and best practices that improve consistency, predictability, and organizational capability across payer integration engagements. • Analyze implementation trends and recurring workflow or interoperability challenges to identify opportunities for process improvement, scalability, and operational efficiency. • Provide expert consultation and real-time workflow and integration guidance during customer engagements, reducing dependency on Product and Engineering resources for operational interpretation and implementation support. • Provide functional leadership, mentorship, and subject matter guidance to implementation team members on payer operations, interoperability concepts, integration strategy, and complex issue resolution. • Serve as a senior advisor during customer strategy and pre-implementation discussions to assess feasibility, clarify integration considerations, and align implementation expectations. • Provide customer -driven feedback to Product and Engineerin g teams r egarding workflow gaps, interoperability chal lenges, implem entation friction points, and enhancement opportunities. • Develop knowledge aids and support cross-functional enablement efforts to strengthen payer workflow a nd integration knowledge across implementation and customer-facing teams. • Use AI-enabled tools and technologies appropriately to improve implementation efficiency, workflow analysis, documentation quality, and knowledge-sharing while ensuring accuracy, security, and alignment with organizational standards. What We're Looking For: • Bachelor’s degree in Healthcare Administration, Information Systems, Computer Science, Business, or a related field, or equivalent combination of education and experience • At least 8 years of experience working with health plan (payer) systems, workflows, operations, and healthcare integrations • Demonstrated experience leading or advising complex healthcare implementations, workflow transformations, or integration initiatives within payer environments • Strong understanding of end-to-end healthcare workflows, particularly within payer operational settings • Demonstrated expertise with healthcare interoperability, system integrations, and data flows across multiple platforms and technologies, including APIs, HL7, FHIR, or related standards • Proven ability to analyze, interpret, and translate business, operational, and technical requirements into scalable implementation guidance and solution approaches • Demonstrated experience navigating highly complex or ambiguous payer operational and integration environments and developing effective solution strategies • Experience working cross-functionally with technical, operational, product, and business stakeholders in matrixed environments • Demonstrated ability to diagnose highly complex workflow and integration issues and recommend effective, scalable solutions • Experience influencing technical and operational decisions without direct authority • Strong communication skills, including the ability to engage effectively with both technical and non-technical audiences • Experience facilitating customer-facing discussions involving technical workflows, interoperability, and implementation strategy Preferred Qualifications: • Knowledge of Healthcare Interoperability Standards such as HL7 Da Vinci , FHIR, and X12 • Knowledge of utilization management and prior authorization operational workflows • Knowledge of provider system workflows and payer-provider interoperability considerations • Experience developing implementation standards, frameworks, reusable methodologies, or operational best practices preferred • Strong written and verbal communication skills • Strong problem-solving skills and ability to develop solutions beyond standard implementation approaches • Demonstrated ability to operate effectively in highly ambiguous and evolving environments • Ability to collaborate across teams and influence stakeholders without direct authority • Ability to facilitate alignment across technical, operational, and customer stakeholder groups • Experience supporting organizational change, process improvement, or implementation scalability initiatives preferred Pay Range: $130,000 - $182,000 Other compensation: Bonus Eligible Perks & Benefits: 💻 Remote work ✈️ Travel expected 3-4 times per year for company-sponsored events 🩺 Medical, dental, vision, life, and disability insurance 📈 401K retirement plan; flexible spending and health savings account 🏝️ 15 days of paid time off + additional front-loaded personal days 🏖️ 14 company-recognized holidays + paid volunteer days 👶 up to 8 weeks of paid parental leave + 10 weeks of paid bonding leave 🌈 LGBTQ+ Health Services 🐶 Pet insurance 📣 Check out more of our benefits here: https://www.mcg.com/about/careers/benefits/ Remote with Occasional Travel (1–3 trips per year) MCG Health is a Seattle, Washington-based company and is considering remote candidates with some travel for company-sponsored events. The ideal candidate should be comfortable balancing the independence of remote work with the collaborative opportunities offered by periodic in-person engagements. We embrace diversity and equal opportunity and are committed to building a team that represents a variety of backgrounds, perspectives, and skills. Only with diverse thoughts and ideas will we be able to create the change we want in healthcare. The more inclusive we are, the better our work will be for it. All roles at MCG are expected to engage in occasional travel to participate in team or company-sponsored events for the purposes of connection and collaboration. It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability. Note on interviews : We may use AI tools to audio-record and transcribe interviews for note-taking purposes. These are used only by our hiring team and do not make decisions on their own. Let us know if you prefer an alternative. MCG is a leading healthcare organization dedicated to patient-focused care. We value our employees' unique differences and are an Equal Employment Opportunity (EEO) employer. Our diverse workforce helps us achieve our goal of providing the right care to everyone. We welcome all qualified applicants without regard to race, religion, nationality, gender, sexual orientation, gender identity, age, marital status, veteran status, disability, pregnancy, parental status, genetic information, or political affiliation. We are committed to improving equity in healthcare and believe that a diverse workplace fosters curiosity, innovation, and business success. We are happy to provide accommodations for individuals. Please let us know if you require any support.

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