Executive Director, Payer Relations
Join the transformative team at City of Hope, where we're changing lives and making a real difference in the fight against cancer, diabetes, and other life-threatening illnesses. City of Hope’s growing national system includes its Los Angeles campus, a network of clinical care locations across Southern California, a new cancer center in Orange County, California, and treatment facilities in Atlanta, Chicago and Phoenix. our dedicated and compassionate employees are driven by a common mission: To deliver the cures of tomorrow to the people who need them today.
The Executive Director, Managed Care Operations & Payer Relations serves as the enterprise leader responsible for operational execution, payer performance governance, and system-wide managed care market leadership for City of Hope. This role oversees payer issue resolution, contract performance optimization, payer scorecard development, escalation strategy, and market-level managed care operations across all hospitals and physician practices, including City of Hope National Medical Center, City of Hope Medical Foundation, and affiliated regional facilities.
As a successful candidate, you will:
• Function as the enterprise authority on payer operational governance, coordinating cross-functional teams to ensure payer compliance, dispute resolution, and performance improvement.
• Ensure contract terms are operationalized effectively, payer obligations are enforced, financial targets are met, and performance deficiencies are escalated and resolved.
• Lead market-level managed care leadership across California and CAP markets and establishes enterprise standards for payer performance oversight, contract enforcement, and managed care operational excellence.
• Provide strategic direction through Directors and Senior Managers across multiple states. This role is accountable for enterprise-wide operational and financial performance of diverse functional areas, and influences system strategy through leadership of cross‑functional managed care operations.
Your qualifications should include:
Minimum Education:
• Master’s degree in Business, Health, or Public Administration (MBA, MHA, MPH, MPA or related field) or Juris Doctor (JD) required.
Minimum Experience:
• 10+ years in managed care, payer operations, or healthcare contracting.
• 7+ years of progressive leadership experience.
• Demonstrated experience managing enterprise payer performance portfolios exceeding $1B in net revenue.
• Experience leading payer dispute resolution and contract enforcement.
• Experience working in capitated and HMO environments.
Required Courses/Training:
• Membership in HFMA and/or ACHE
• Active in CHA and HASC managed care committees
Preferred Experience:
• Oncology center or academic medical center experience.
• Experience in value-based payment models.
• Experience implementing payer performance scorecards.
Skills/Abilities:
• Proven ability to lead diverse operational teams through subordinate Directors and Managers.
• Demonstrated effectiveness in driving enterprise‑level operational strategy in complex and dynamic environments.
• Strong ability to influence senior executives, regulators, and external partners in high‑stakes negotiations.
• Advanced financial acumen
• Contract interpretation and enforcement expertise
• Executive-level negotiation and escalation skills
• Strong cross-functional leadership capability
• Enterprise operational governance experience
• Strategic and systems-level thinking
City of Hope employees pay is based on the following criteria: work experience, qualifications, and work location.
City of Hope is an equal opportunity employer. To learn more about our commitment to diversity, equity, and inclusion, please click here.
To learn more about our Comprehensive Benefits, please CLICK HERE.
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The Executive Director, Managed Care Operations & Payer Relations serves as the enterprise leader responsible for operational execution, payer performance governance, and system-wide managed care market leadership for City of Hope. This role oversees payer issue resolution, contract performance optimization, payer scorecard development, escalation strategy, and market-level managed care operations across all hospitals and physician practices, including City of Hope National Medical Center, City of Hope Medical Foundation, and affiliated regional facilities.
As a successful candidate, you will:
• Function as the enterprise authority on payer operational governance, coordinating cross-functional teams to ensure payer compliance, dispute resolution, and performance improvement.
• Ensure contract terms are operationalized effectively, payer obligations are enforced, financial targets are met, and performance deficiencies are escalated and resolved.
• Lead market-level managed care leadership across California and CAP markets and establishes enterprise standards for payer performance oversight, contract enforcement, and managed care operational excellence.
• Provide strategic direction through Directors and Senior Managers across multiple states. This role is accountable for enterprise-wide operational and financial performance of diverse functional areas, and influences system strategy through leadership of cross‑functional managed care operations.
Your qualifications should include:
Minimum Education:
• Master’s degree in Business, Health, or Public Administration (MBA, MHA, MPH, MPA or related field) or Juris Doctor (JD) required.
Minimum Experience:
• 10+ years in managed care, payer operations, or healthcare contracting.
• 7+ years of progressive leadership experience.
• Demonstrated experience managing enterprise payer performance portfolios exceeding $1B in net revenue.
• Experience leading payer dispute resolution and contract enforcement.
• Experience working in capitated and HMO environments.
Required Courses/Training:
• Membership in HFMA and/or ACHE
• Active in CHA and HASC managed care committees
Preferred Experience:
• Oncology center or academic medical center experience.
• Experience in value-based payment models.
• Experience implementing payer performance scorecards.
Skills/Abilities:
• Proven ability to lead diverse operational teams through subordinate Directors and Managers.
• Demonstrated effectiveness in driving enterprise‑level operational strategy in complex and dynamic environments.
• Strong ability to influence senior executives, regulators, and external partners in high‑stakes negotiations.
• Advanced financial acumen
• Contract interpretation and enforcement expertise
• Executive-level negotiation and escalation skills
• Strong cross-functional leadership capability
• Enterprise operational governance experience
• Strategic and systems-level thinking
City of Hope employees pay is based on the following criteria: work experience, qualifications, and work location.
City of Hope is an equal opportunity employer. To learn more about our commitment to diversity, equity, and inclusion, please click here.
To learn more about our Comprehensive Benefits, please CLICK HERE.
Apply tot his job
Apply To this Job