Develops and manages a portion of the Pennsylvania physician/provider network. Engages with providers and health system administration as well as internal stakeholders to drive high performance in quality and cost efficiency. Designs and implements programs to maintain positive relationships between the health plan, providers, and health system entities.
Requires at
Coverage Area - Pennsylvania
Car & valid driver's license required (mileage reimbursement provided)
Job Role and Responsibilities:
Responsible for general oversight of provider network financials, including monthly action plans, reviews, and verification as it relates to value based incentive contracts and performance. Develops and implements programs to achieve enhanced quality and affordability through physician education, training and provision of reporting. Use analytics resources to identify key opportunities for utilization and cost management
Provides guidance on strategic plans, vision, and action plan development for value-based agreements with health systems for areas including but not limited to, financial performance, including medical cost ratio and other cost and utilization metrics, and STARs (HEDIS & Part D) quality performance
Prepares for and facilitates external physician meetings, including Joint Operating Committees with health system leadership and large physician group meetings. Develop and maintain positive relationships with physicians, providers, and health systems within the provider network
Coordinates or participates in cross functional/department collaboration with other internal departments, including but not limited to Health Services, Medical Economics, Sales, and Coding in order to develop solutions for strategic business needs
Prepares for and facilitates a monthly financial review to senior management, including but not limited to financials, quality and coding progress, action plans, reviews/evaluations and any accompanying analysis
Responsible for maintaining compliance to CMS and company policies and guidelines
Responsible for supervising, including regular coaching and development, of the Senior Network Analyst position
Qualifications:
Self-motivated and ability to operate independently
Excellent analytical and problem-solving capabilities
Demonstrated proficiency of interpersonal and communication skills
Demonstrated ability to effectively adapt to new situations and handle ambiguity
Customer service experience with focus on meeting customer needs
Requires local travel to network providers
Coverage Area - Pennsylvania
Car & valid driver's license required (mileage reimbursement provided)
Minimum Requirements:
Bachelor's degree (BA/BS in Business, Healthcare, Operations Management, Finance, or related field preferred)
At least three years related experience
Preferred Requirements:
Master's Degree
Experience in physician relations or managed care
Management/Supervision experience
This role is Flex/WFH which allows most work to be performed at home or on occasion at a Cigna office location. Employees must be fully vaccinated if they choose to come onsite.
About Cigna
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.
