The Provider Performance Enablement (PPE) Senior Manager is an integral part of a cross-functional, collaborative organization (which includes Market Provider Performance, Sales, Health Services, Clinical, Stars & Risk Adjustment, Finance, Marketing, Cross-Segment Contracting, Provider Relations, and Network Development & Solutions). Reporting to the Medicare Market President/Operations Senor Director, this individual ensures the effective management of the provider network for the assigned to the Carolina's market.
The Provider Performance Senior Manager's responsibilities include:
Leading and managing the PPE team in the assigned Carolina's market and developing and managing the local physician/provider network, engaging with providers and internal stakeholders to drive high performance in quality and cost efficiency, designing and implementing programs to maintain positive relationships between the health plan, physician, providers, and practice managers.
Responsible for supervising, including regular coaching and development, of Provider Performance Manager(s).
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.
Providing feedback and recommendations regarding participation or non-participation with new or existing agreements and financial and/or operational issues with providers.
Participating in market strategy, compliance, and delegation oversight.
Supporting Stars & Risk Adjustment initiatives through local Provider Performance initiatives. Developing and implementing programs to achieve enhanced quality and affordability through physician education, training and provision of reporting and using analytics resources to identify key opportunities for utilization and cost management.
Acting as government program knowledge leader for the local market.
Responsible for maintaining compliance to CMS and company policies and guidelines.
Leading market initiatives and performing special projects and other duties as assigned by leadership.
Role Components
All market team members contribute to the growth and profitability of the Medicare Advantage business in their market in the following aspects:
Growing the MA Business: The Provider Performance Senior Manager is accountable for the growth of the assigned (specify domain here - sub-market, provider groups or territories) in terms of financial profitability, increase in provider network and membership Delivering our Services: The Provider Performance Senior Manager is accountable for the exceptional delivery of services in the assigned (specify domain here - sub-market, provider groups or territories) as evidenced by physician and member satisfaction, improvements on Star Rating and NPS score.
Managing our Costs: The Provider Performance Senior Manager ensures the affordability of services in the assigned (specify domain here - sub-market, provider groups or territories) by effective control of various cost levers like Med/OPEX.
Developing our People: The Provider Performance Senior Manager provides leadership and management across team/s in the assigned (specify domain here - sub-market, provider groups or territories). He/she ensures the effective coaching and management of these teams.
Collaborating with our Partners: The Provider Performance Senior Manager seamlessly collaborates with all applicable partners to 'solve for Cigna', and may lead cross-market initiatives that improve service delivery within the business.
Qualifications and Competencies
Location: Preference for candidate to be based in Charlotte or Triad, NC region or Upstate South Carolina
Education: Bachelor's degree or equivalent work experience required, Master's degree or MBA preferred
Work History: 8+ years of direct provider-facing experience or direct health plan experience with STARS, HEDIS, Risk Adjustment and medical expense reduction, preferably specific to Medicare Advantage
Leadership: 3+ years management experience required
Ability to apply an enterprise mindset with business acumen resulting in meeting or exceeding goals in growth and profitability
Data extraction experience required, Tableau experience strongly preferred
Demonstrate strategic thinking, customer focus and proven ability to develop strong, lasting relationships with providers resulting in deeper collaboration and satisfaction
Capacity for leading initiatives and influencing people on market teams; ability to drive transparency and accountability, and learn the strengths and weaknesses of the team so as to inform leadership to put people in a position to succeed
Ability to develop strong relationships across multiple levels of the organization
Effective communicator
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
About Cigna Healthcare
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.
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.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
