Full Job Description
This position serves as an integral member of the Medicare Advantage Expansion Provider Contracting Team and reports to the Provider Contracting Senior Manager. This role is a key contributor to the development of the strategic direction and is accountable for the management of the day to day contracting and network management activities in South Florida.
DUTIES AND RESPONSIBILITIES
Experience with leading complex contracting and negotiations for sophisticated fee for service and value-based reimbursements with hospitals and other providers (e.g., Hospital systems, Ancillaries, and large physician groups).
Manages the development and provides guidance on strategy, vision, and action plan development for the Cigna Medicare book of business
Responsible for network development, including contracting, rate negotiations, network relationships, network communication, and network partnerships as well as expansion of network and products offered by Health plan partners
Proactively builds relationships in expansion territories 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 Management. Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing and Service.
Meet with providers on a regular basis to ensure the exceptional delivery of quality and service are meeting expectations as evidenced by STARS, NPS, and satisfaction survey scores.
Manages strategic positioning for provider contracting, develops networks and identifies opportunities for greater value-orientation and risk arrangements.
Identifying and implementing the development of alternative network initiatives. Supports and provides direction to develop network analytics required for the network solution.
Responsible for meeting unit cost targets, while preserving an adequate network, to achieve and maintain Cigna’s competitive position.
Assist with market’s HEDIS, CAHPS, and HOS strategy in collaboration with matrix partners in STARS, Risk Adjustment, and Care Management teams. Implement data-driven efficiencies for gap closure (e.g. supplemental data feeds, HIE, HL7), and negotiate implementation and usage of record exchange through SFTP site transfers and EMR access.
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 expectations. Ensures the accurate implementation, and administration through matrix partners.
Assists in resolving elevated and complex provider service complaints. Researches 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.
May provide guidance or expertise to less experienced specialists.
Bachelor’s degree strongly preferred; preferably in the areas of Finance, Economics, Healthcare or Business related. Significant industry experience will be considered in lieu of a Bachelor degree. MBA or MHA preferred.
Three to five years contracting and negotiating experience involving complex delivery systems and organizations required; Medicare contracting experience required and preferably with expansion expertise.
Experience in developing and managing key provider relationships
Knowledge of complex reimbursement methodologies, including incentive based models strongly 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 skills. Experience 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.
Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you’ll enjoy meaningful career experiences that enrich people’s lives. What 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.
If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.