Provider Contracting Senior Manager (Idaho) - Cigna Healthcare - Remote

Provider Contracting Manager

This position serves as an integral member of the Provider Contracting Team and reports to the Vice President of Provider Contracting. This role is a key contributor to the development of the strategic direction and is accountable for the management of contracting and network management activities for multiple local geographies.

DUTIES AND RESPONSIBILITIES

• Directly manages a contracting team or geography, providing leadership and mentoring to their direct reports
• Manages increasingly complex contracts and negotiations for fee for service and sophisticated value-based reimbursements with hospitals and other providers (e.g., Hospital systems, Ancillaries, and large physician groups) for one or more geographies
• Proactively builds relationships that nurture provider partnerships and seeks broader value-based business opportunities to support the local market strategy
• Acts as a market leader for Cigna in the community and represents Cigna as needed at community events, on workgroups, and with government agencies and regulators
• Initiates, nurtures 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
• Manages strategic positioning for provider contracting, develops networks and identifies and acts upon opportunities for greater value-orientation and risk arrangements
• Identifying and implementing 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
• Identify 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 high spend or increasingly complex provider contracts and alternate contract terms
• Creates and / or oversees the development of "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 comprehensive 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

POSITION REQUIREMENTS