Vacancy expired!
This position serves as an integral member of the Provider Contracting Team and reports to the Assistant Vice President of Network Management (Provider Contracting Senior Manager).
This role assists in developing the strategic direction and management of the day to day contracting and network management activities for a given territory.
DUTIES AND RESPONSIBILITIES
Manages complex contracting and negotiations for fee for service and value-based reimbursements with large physician groups, ancillary providers and hospitals, as applicable.
Prepares and analyzes financial impact of larger or complex physician and ancillary contracts.
Mentors a team of individuals who primarily negotiate ancillary and physician contracts.
Demonstrates knowledge and builds external relationships with providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape.
Manages strategic positioning for provider contracting and identifies opportunities for greater value-orientation.
Participates in the annual total medical cost planning process by setting aggressive unit cost targets and by developing alternative affordability initiatives.
Meets or exceeds unit cost targets, while preserving an adequate network, to achieve affordability goals for Cigna's Commercial and Medicare Advantage Products.
Supports projects and initiatives relative to local and regional affordability goals.
Contributes to the development of alternative network initiatives and new products. Supports and provides direction to develop network analytics required for the network solution.
Drives change with external provider partners by assessing clinical informatics and offering consultative expertise to assist with total medical cost initiatives.
Ensures accurate contract implementation and administration through matrix partners.
Researches and provides issue resolution for physician and ancillary providers.
Initiates and maintains effective channels of communication with matrix partners including but not limited to, Provider Services, Claims Operations, Medical Management.
Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing.
POSITION REQUIREMENTS
Should possess a bachelor degree, preferably in the areas of Finance, Economics, Healthcare or Business related. Significant industry experience will be considered in lieu of a Bachelor degree.
Five years or more years contracting and negotiating experience involving complex healthcare delivery systems and organizations required.
Prior management experience preferred.
Knowledge of complex reimbursement methodologies, including incentive based models strongly preferred.
Intimate understanding and experience with managed care and provider business models.
Team player with proven ability to develop strong working relationships within a fast-paced, matrix organization.
The ability to influence provider audiences through strong written and verbal communication skills.
Superior problem solving, decision-making, negotiating skills, priority-setting and financial acumen.
Knowledge and use of Microsoft Office tools.
Vacancy expired!