Director, Network Management - Cigna Healthcare - Remote, Idaho

DUTIES AND 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.

POSITION 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.