Director Provider Contracting Network Management - Atlanta, GA market - Cigna Healthcare - Hybrid

The Cigna Group • Atlanta, GA • 10h ago

WORK LOCATION: Atlanta, GA

The Director Provider Contracting Network Management serves as an integral member of the Provider Contracting Team and reports to the AVP, Provider Contracting. This role assists in developing the strategic direction and management of the day to day contracting and network management activities for a local given territory.

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).

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.

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 healthcare provider agreements that meet internal operational standards and external provider expectations. Ensures the accurate implementation, and administration through matrix partners.

Assists 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.

May provide guidance or expertise to less experienced specialists.

POSITION REQUIREMENTS:

Should possess a bachelor's degree; preferably in the areas of Finance, Economics, Healthcare or Business related. Significant industry experience will be considered in lieu of a bachelor's degree. MBA or MHA preferred.

3+ years Managed Care contracting and negotiating experience involving complex delivery systems and organizations required.

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 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.

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.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Similar Jobs

Medical Assistant (in office)

315 health • Douglasville, GA • 4h ago

Hospital & Medical

Our partner in healthcare, Family Practice in Douglasville, is looking for a phenomenal medical assistant with several years experience. This position will be based in our Douglasville, GA office. . As a Medical assistan...

4h ago

Go to Apply

Dental Hygienist (RDH)

Aspen Dental • Dunwoody, GA • 4h ago

Hospital & Medical

At Aspen Dental, we put You 1st with world-class development plus industry-leading pay. Join our team today as a Dental Hygienist! Job Types: Full-time, Part-time Salary: $83,000 - $87,000 per year (annualized base salar...

4h ago

Go to Apply

Advanced Degree Software Engineer - Oracle Health and Analytics

Oracle • Atlanta, GA • 12h ago

Hospital & Medical

Job Description FTE - Intended for students graduating with their Master's or Doctorate's degree by, or have graduated within, 12 months of cohort start date in June/July 2026. Target Start Date: early-June or mid-July 2...

12h ago

Go to Apply

Acquisition Account Executive, Healthcare

Zoom • Alpharetta, GA • 13h ago

Hospital & Medical

What you can expect Zoom is looking for Acquisition Account Executives specializing in Healthcare to sell our Zoom Workplace. Our Acquisition AEs are tenacious hunters and prospectors that create opportunities to sell th...

13h ago

Go to Apply

Acquisition Account Executive, Healthcare

Zoom • Atlanta, GA • 13h ago

Hospital & Medical

13h ago

Go to Apply

Acute Care Research Nurse II - Vascular Surgery

Emory Healthcare/Emory University • Atlanta, GA • 14h ago

Hospital & Medical

Discover Your Career at Emory University Emory University is a leading research university that fosters excellence and attracts world-class talent to innovate today and prepare leaders for the future. We welcome candidat...

14h ago

Go to Apply

Administrative Assistant - School of Medicine, Division of Rheumatology and Immunology

Emory Healthcare/Emory University • Atlanta, GA • 17h ago

Hospital & Medical

17h ago

Go to Apply

Pharmacy Administrative Assistant

BrightSpring Health Services • Duluth, GA • 17h ago

Hospital & Medical

Our Company Amerita Overview Amerita, Inc. is a leading provider in home Infusion therapy. We are looking for an Administrative Assistant to join our team as we grow to be one of the top home infusion providers in the co...

17h ago

Go to Apply

PAR Collections - Medical Records

Fresenius Medical Care North America • Kennesaw, GA • 18h ago

Hospital & Medical

You will be able to work from your home location within the United States PURPOSE AND SCOPE: The Patient Account Representative - Collections provides administrative support to the collections operations within the assig...

18h ago

Go to Apply

NKP Account Manager - Healthcare/SLED

Nutanix • Atlanta, GA • 19h ago

Hospital & Medical

Hungry, Humble, Honest, with Heart. The Opportunity As a Sr Nutanix Kubernetes Platform (NKP) Sales Specialist at Nutanix, you will be an essential part of our Modern Applications sales team selling into the Healthcare &...

19h ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.