Role Summary
Reporting to the RVP of Network Management, this position has overall accountability for managing the hospital and physician provider contracting functions in the assigned US Market. This role has market level accountability for executing the Regional/National Network Contracting & Affordability strategy within the market, and also partners closely with leadership from key matrix partners to develop and implement the market strategy to support medical cost improvement and profitable growth in the assignment market. The Market Network Leader is also responsible for managing total medical cost for the market, including the execution of a total unit cost plan, provider collaborative and value-based initiatives, and network access and provider satisfaction/network stability across all Cigna products.
Duties & Responsibilities
Within the markets, leads the technical operations of the Contracting functions, including service area analysis, physician contracting, network development, and problem resolution.
Contributes to and executes the markets strategic planning, direction and evaluation of the Contracting departments.
Partners closely with leadership from our key matrix partners from Sales, Underwriting, Medical Economics, etc. in developing and implementing a market strategy to support medical cost improvement and profitable growth in this market.
Leads and participates in market-based vendor negotiations. Interfaces with senior leaders in the medical community. Negotiates, evaluates and writes physician contracts in order to partner with quality, cost-effective providers of healthcare services within the defined geographic area and drives competitive unit cost relative to top tier competitors across all Cigna products. Conducts market-based financial analysis and participates in cross-functional teams to analyze business opportunities and address critical issues (e.g. network growth, provider termination, etc.)
Supports growth and persistency through strategic collaboration with Market Medical Execs, Sales and Account Management to achieve Regional/Market Segment Sales goals
Executes/ensures compliance with Cigna Healthcare National Contracting standards
Drives improvement in market Provider and Member satisfaction results by partnering with Medical Management, Marketing, Finance, and Service Organization staff
Identifies opportunities for service improvements and cost savings. Manages the execution of market-based total medical cost plans and manages medical expenses across all Cigna products
Participates in the development of financial plans, business plans and strategy to support administrative, financial, and marketing objectives
Manages the markets provider relationships and identifies opportunities for improvement in provider education and communication
Ensures that provider data is loaded timely and accurately in support of administrative and accuracy objectives
Responsible for People Strategy within their department, including successful execution of all attraction, development, motivation and retention efforts
Coordinates all budget and expense management activities through effective planning, monitoring and forecasting
Qualifications:
Bachelor's Degree; MBA or Master's Degree in HealthCare Administration or health-related field preferred
Minimum of 10 years managed healthcare experience
Extensive experience (10 years, preferred) in provider contracting and network development involving complex hospital systems, integrated delivery systems and large physician groups (IPAs and PPMs) etc., including risk arrangements
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.)
Excellent interpersonal and relationship management skills
Excellent oral, written and presentation skills
Proven ability to function 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 charge of business operations. Proven ability to drive and lead an organization through significant change
Strong organizational and analytical skills that result in conclusive recommendations
Ability to drive results, think strategically and implement a national strategy
Ability to establish community-based partnerships with providers and other stakeholders
Proficient with Excel, Word and presentation applications
Technical/Functional expertise: Contracting, Negotiating, Provider Services, Financial Management, Project Management
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.
For this position, we anticipate offering an annual salary of 177,400 - 295,600 USD / yearly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus and long term incentive plan.
At The Cigna Group, you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here (https://jobs.thecignagroup.com/us/en/benefits) .
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.
