Director, Network Management
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Job Description
Director of Network Management at Cigna Healthcare managing provider contracts and relationships. Leading strategic initiatives for provider contracting and partnerships in healthcare marketplace.
Responsibilities:
- Manages complex contracting and negotiations for fee for service and value-based reimbursements with hospitals and other providers (e.g., Hospital systems, Ancillaries, and large physician groups).
- May lead a team with direct reports.
- Point person for complex projects related to contracting strategy in the market.
- Builds relationships 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.
- Manages strategic positioning for provider contracting, develops networks and identifies opportunities for greater value-orientation and risk arrangements.
- Contributes to the development of alternative network initiatives.
- Supports and provides direction to develop network analytics required for the network solution.
- Works to meet unit cost targets, while preserving an adequate network, to achieve and maintain Cigna's competitive position.
- 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.
- Leads 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.
Requirements:
- Should possess a bachelor degree; 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.
- 5+ years contracting and negotiating experience involving complex delivery systems and organizations required.
- Significant experience leading and mentoring others.
- 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.
Benefits:
- Health insurance
- 401(k) matching
- Paid time off
- Flexible work arrangements
- Professional development opportunities
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