Remote, work from home - Philadelphia, PA (must be located in/or near market)
Description:
This position serves as an integral member of the Market Team and reports to a Network Operations Director/ Senior Manager in the Pennsylvania market. This role develops and executes the strategic network plan for providers, health systems and ancillaries and is accountable for the management of relationships and performance, including value based relationships for assigned geographies, and for expanding into potential other markets. This role is responsible for effective management of Medicare Advantage provider network in assigned territory, to include:financial performance, quality/Medicare Star rating program initiatives, provider data accuracy, trend analysis, and provider engagement.
Responsibilities:
Participates in the development and execution of market strategies that align with local, regional and national business direction and initiatives
Executes on and coordinates network strategies that drive affordability, compliance and marketability through the utilization of Cigna contract enablement guidelines
Collaborates closely with matrix partners in Sales/Marketing, Coding, STARs, Health Services, Medical Economics, Cross Segment Contracting and Medical Leadership in developing and implementing an effective value-based market strategy to support medical cost improvement and profitable growth
Lead for value based contracting for the market and consults, in conjunction with the Cross Segment contracting team, for complex contracting and negotiations for fee for service with large physician groups, ancillary providers and hospitals/health systems
Develops and enhances relationships with market-based partners and senior leaders in the medical community. Identifies innovative opportunities for collaboration and partnership in the market
Oversees the technical operations of the contracting functions, including network analysis, provider contracting and implementation, network development, provider issues resolution and regulatory compliance
Conducts market-based financial analysis and participates in cross-development matrix teams to analyze business opportunities and address critical issues (e.g. network growth, provider termination, etc.)
Supports development of network strategy and execution for geographic and product expansions in aligned and contiguous territories
Participates in the development of financial plans, business plans and strategy to support administrative, financial, and marketing objectives.
Ensures that provider data is loaded timely and accurately in support of administrative and provider data accuracy objectives and compliance requirements
Supports growth and persistency through strategic collaboration with Market Medical Execs and Sales to achieve Regional/Market Segment Sales goals
25% of local travel.
Requirements:
Bachelor Degree strongly preferred, MBA or Master Degree in HealthCare Administration or health-related field preferred, or equivalent, related experience.
5 years or more of managed healthcare experience preferred
Extensive experience (5 years, preferred) in provider contracting, especially value based contracting and risk arrangements and network development involving complex hospital systems, integrated delivery systems and large physician groups (IPAs and PPMs) etc.,
Excellent knowledge of hospital and managed care finance
Strong knowledge of managed care (e.g. network design, products, customer service, provider communities, etc.) regulatory environment and compliance issues (e.g. NCQA accreditation issues, credentialing, delegation and oversight standards, etc.)
Superb interpersonal and relationship management skills
Entrepreneurial mindset with the knack for understanding and leveraging competitive intelligence
Excellent oral, written, presentation, and facilitation skills
Proven ability to function successfully in a heavily matrixed environment
Proven ability to foster collaboration, value others perspective and gain support and buy-in for organization proposals
Proven success in managing growth and leading change in a fast-paced organization.
Strong organizational, analytical, and critical thinking skills that result in conclusive recommendations and sound decisions.
This role is Work from home, 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.
