Job Summary
The Director of Managed Care develops and implements managed care and payer relations strategies including contract negotiation and management of payer relationships for all Cedars-Sinai-owned and affiliated entities including hospitals, physician groups, individual practice association (IPAs), accountable care organizations, and procedural/surgery centers. Responsible for negotiating insurance contracts and payer agreements that enable Cedars-Sinai to meet its financial objectives and mission through continuous and thorough analysis in evaluating existing structures and rates. Provides leadership to maintain effective payer partnerships through establishing, maintaining and growing relationships with internal and external stakeholders involved in the contracting process, developing contract language and negotiation strategy, and in-depth financial analyses of contract performance. Oversees assigned Health Plans in scope and serves as key business contact between Cedars-Sinai entities and payers to resolve issues as they arise including operational, financial, payment, clinical, policy interpretations and others. Provides leadership, guidance and supervision to staff towards the accomplishment of organizational goals.
Primary Duties & Responsibilities
- Leads the negotiation, development, and monitoring of contracts across all Cedars-Sinai entities, serving as the primary contact for major payers (e.g., Anthem, United, Aetna).
- Develops negotiation strategies and contract structures including fee-for-service, capitation, bundled payments, value-based care, and pay-for-performance models.
- Performs in-depth financial analyses to assess contract performance and guides decisions on renewal, cancellation, or renegotiation.
- Oversees the Letter of Agreement (LOA) process for non-contracted and out-of-network payers in coordination with Registration, Admissions, Payer Revenue Management, and Service Lines.
- Supports recovery of unpaid/underpaid receivables and serves as liaison between internal departments and health plans.
- Supervises contracting efforts that support patient referrals and participation in specialty networks (e.g., transplant services).
- Manages analytics and actuarial support for both facility and physician contracts, including at-risk arrangements.
- Provides market insights on payer trends, coding protocols, regulatory changes, and emerging technologies to guide strategy and protect revenue.
- Collaborates with internal stakeholders and industry groups (e.g., CHA, HASC, APG) to shape and align Cedars-Sinai’s managed care strategy.
Education:
- Bachelor's Degree Required - Business, Finance, health care or a related field
- Master's Degree Preferred- Master of Business Administration (MBA), Master of Healthcare Administration (MHA), Master of Public Health (MPH), or a related field
Work Experience:
- Minimum of 10 years of progressive experience in managed care contracting at the management or supervisory level, within a health plan or provider setting. At least 3 of those years should be within a large, diverse health system, with specific experience in hospital and physician contracting. Must have a strong understanding of risk-based arrangements and capitation management.
Cedars-Sinai is a leader in providing high-quality healthcare encompassing primary care, specialized medicine and research. Since 1902, Cedars-Sinai has evolved to meet the needs of one of the most diverse regions in the nation, setting standards in quality and innovative patient care, research, teaching and community service. Today, Cedars- Sinai is known for its national leadership in transforming healthcare for the benefit of patients. Cedars-Sinai impacts the future of healthcare by developing new approaches to treatment and educating tomorrow's health professionals. Additionally, Cedars-Sinai demonstrates a commitment to the community through programs that improve the health of its most vulnerable residents.
Req ID : 10874
Working Title : Managed Care and Payor Relations Director, Managed Care - #1 Hospital in CA
Department : Managed Care and Payor Relations
Business Entity : Cedars-Sinai Medical Center
Job Category : Strategic Plan / Business Dev
Job Specialty : Managed Care
Overtime Status : EXEMPT
Primary Shift : Day
Shift Duration : 8 hour
Base Pay : $87.49 - $157.48
