Job type full-time
Full job description
This role is flex/wfh which allows most work to be performed at home or on occasion at a cigna office location.
This position serves as an integral member of the provider contracting team and reports to the provider contracting senior manager or vp of contractingThis role assists in developing the strategic direction and management of the day to day contracting and network management activities for a local given territory.
Duties and responsibilities
Manages complex contracting and negotiations for fee for service and value-based reimbursements with hospitals and other providers (e.g., hospital systems, ancillaries, and large physician groups).
May lead a team with direct reports.
Point person for complex projects related to contracting strategy in the market.
Builds relationships that nurture provider partnerships and seeks broader value-based business opportunities to support the local market strategy.
Initiates and maintains effective channels of communication with matrix partners including but not limited to, claims operations, medical managementCredentialing, legal, medical economics, compliance, sales and marketing and service.
Manages strategic positioning for provider contracting, develops networks and identifies opportunities for greater value-orientation and risk arrangements.
Contributes to the development of alternative network initiativesSupports and provides direction to develop network analytics required for the network solution.
Works to meet unit cost targets, while preserving an adequate network, to achieve and maintain cigna`s competitive position.
Creates and manages initiatives that improve total medical cost and quality.
Drives change with external provider partners by assessing clinical informatics and offering consultative expertise to assist with total medical cost initiatives.
Prepares, analyzes, reviews, and projects financial impact of larger or complex provider contracts and alternate contract terms.
Creates “hcp” agreements that meet internal operational standards and external provider expectationsEnsures the accurate implementation, and administration through matrix partners.
Leads in resolving elevated and complex provider service complaintsResearches problems and negotiates with internal/external partners/customers to resolve highly complex and/or escalated issues.
Manages key provider relationships and is accountable for critical interface with providers and business staff.
Demonstrates knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape.
Responsible for accurate and timely contract loading and submissions and interface with matrix partners for network implementation and maintenance.
Bachelor’s degree, strongly preferred; preferably in the areas of finance, economics, healthcare or business relatedSignificant industry experience will be considered in lieu of a bachelor degreeMba or mha preferred.
Five years or more years contracting and negotiating experience involving complex delivery systems and organizations required.
Significant experience leading and mentoring others.
Experience in developing and managing key provider relationships
Knowledge of complex reimbursement methodologies, including incentive based models strongly preferred.
Experience with medicare/medicare advantage fee for service and fee for value contracting and reimbursement methodologies strongly preferred.
Prior experience with network development strategy and builds preferred.
Demonstrated experience in seeking out, building and nurturing strong external relationships with provider partners.
Intimate understanding and experience with hospital, 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 both sales and provider audiences through strong written and verbal communication skillsExperience with formal presentations.
Customer centric and interpersonal skills are required.
Demonstrates managerial courage as well as an ability to maneuver effectively in a changing environment.
Superior problem solving, decision-making, negotiating skills, contract language and financial acumen.
Knowledge and use of microsoft office tools.
10% travel locally
We are looking for someone to be located in ct, ma, ri or nyEmployees must be fully vaccinated if they choose to come onsite.
Cigna corporation exists to improve livesWe are a global health service company dedicated to improving the health, well-being and peace of mind of those we serveTogether, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millionsThrough our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovationWhen you work with us, or one of our subsidiaries, you’ll enjoy meaningful career experiences that enrich people’s livesWhat difference will you make?
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
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