- 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.
- 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.
- 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.
- 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 degree. MBA or MHA preferred
- 3+ years of Healthcare Provider 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 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.
- Proficient with Microsoft Office (Word, Excel, PowerPoint, Outlook)
- Requires ability for local travel to Network Providers
-
Manager, Provider Contracting
1 week ago
The Cigna Group Newton, United States**LOCATION: Based in Newton, MA office** · The **Manager, Provider Network Contracting** serves as an integral member of the Provider Contracting Team and reports to the Provider Contracting Senior Manager. This role assists in developing the strategic direction and management of ...
-
Manager, Provider Contracting
1 week ago
Cigna Newton, United StatesLOCATION: Based in Newton, MA office · The Manager, Provider Network Contracting serves as an integral member of the Provider Contracting Team and reports to the Provider Contracting Senior Manager. This role assists in developing the strategic direction and management of the da ...
-
Manager, Provider Contracting
3 weeks ago
Cigna Health and Life Insurance Company Newton, United StatesForward to localhost with CLI · whcli forward --token=300ea846-107c-4d8d-95bc-90df0ba1dffb · Install whcli · generates free, unique URLs and e-mail addressesand lets you see everything that's sent there instantly. · Built-in integrations: Google Sheets, Excel, Slack, Dropbox, ...
-
Manager, Provider Contracting
2 days ago
The Cigna Group Newton, United States OTHERThe job profile for this position is Provider Contracting Advisor, which is a Band 4 Senior Contributor Career Track Role.Excited to grow your career? · We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiti ...
-
Employment - Provider Contract Analyst
3 weeks ago
Cigna Newton, United StatesJob Description: · Cigna Network Academy is an intensive multi-week (June-August) training program designed for early career hires, focused on developing business acumen, negotiation, and relationship building skills required to quickly onboard and contribute to Cigna's focus on ...
-
Operations Compliance Specialist
3 weeks ago
The RMR Group Newton, United StatesOverview: · The Operations Compliance Specialist ensures the accuracy and compliance of all Service Contracts/Service Orders, Construction Contracts, Certificates of Insurance as well as the Building Engines - CMMS (Work Order) System control. The Operations Compliance Specialist ...
-
Finance Assistant
2 weeks ago
Project Self-Sufficiency Newton, United StatesFull-time associate needed to provide a variety of grant-related support and fiscal services. · - Responsibilities_ · - Scan, file, and log account documents. · - Update computerized accounting systems. · - Research, analyze, and prepare documents and reports to meet grant requir ...
-
Order Management Specialist
3 weeks ago
CyberArk Newton, United StatesDate: Apr 10, 2024- Location: US - Massachusetts, Newton- Job Category: Finance- Department: Corporate Functions (HR, Finance, Legal)**Who we are**: · **About this role**: · CyberArk is seeking a detail-oriented Order Management Specialist to join a growing Order Process Manageme ...
-
Piano and Guitar Teachers Wanted
2 weeks ago
Mark West Music Network Newton, United StatesLooking to add on new students to your schedule? I am a piano teacher myself and I run a network of music instructors, working with other music teachers and assigning them new students. I have been working with teachers from all walks of life for 5+ years and I would love to work ...
-
Real Estate Listing and Buyer's Agents Needed
3 weeks ago
Popular Properties Realty, Inc. Newton, United StatesAre you determined to help buyers find the home of their dreams? We're looking for a knowledgeable and enthusiastic buyer's agent to join our team. You'll act as the buyer's main point of contact from the first message to the final sale and ensure they have a positive experience ...
-
Summer Camp Mental Health Specialist
2 weeks ago
Camp Nejeda Foundation Newton, United States**MESH Specialist** · Mental Emotional Social Health Specialist · Seasonal: June 24 - August 16 · **Purpose**: · - To provide ongoing psychosocial support to campers and staff in the camp environment · - To help address camper and/or counselor psychosocial issues and crises as th ...
-
Facilities Coordinator
2 weeks ago
West Suburban YMCA Newton, United States**Facilities Coordinator** · West Suburban YMCA, Newton, MA, US · **Salary Range**:$20.00 To 23.00 Hourly · The WSYMCA is searching for a Facilities Coordinator to join our team We are looking for an organized and enthusiastic individual to take on this role that will support our ...
-
Property Manager
1 week ago
Barkan Management Company Newton, United States**Join our growing team** · If you are looking for a rewarding role with opportunities for growth at a company that values integrity, innovation, and teamwork, look no further Barkan Management Company is a leading property management firm serving over 200 residential communities ...
-
Executive Assistant
1 week ago
Newton Public Schools Newton, United StatesJobID: 4889 · **Position Type**: · Secretarial/Secretary**Date Posted**: · 4/24/2024**Location**: · Newton North High School · **Department**: · **Athletics and PE, Health and Wellness Departments** · **Job Title**: · **Executive Assistant** · **FLSA Status**: · **(Exempt/Non-exe ...
-
Global Account Director, Corporate Total Account
2 weeks ago
Sonesta Newton, United States**Job Description Summary** · Environment · - ** Operational/Functional**: · - Oversee and actively manage assigned accounts and preferred partnerships in the Business Travel and Group Segment via targeted customer facing meetings and opportunities. · - Effectively promote the So ...
-
Transport Maint Crew Chief/ Newton Maint
2 weeks ago
Texas Department of Transportation Newton, United States**Transport Maint Crew Chief/ Newton Maint** **-** **(**2401924**)** · **Position Information** · **Minimum Monthly Salary**: (A20) $4,013.17/mo · **Maximum Monthly Salary**: (A20) $6,456.42/mo · **Physical Work Location**:1009 West Court Street, US 190, 0.5 MI W OF HWY 87, Newto ...
-
Production worker
5 days ago
Eclipse Technologies Newton, MA, United States FreelanceAs one of the most successful and innovative personnel service companies in Germany, we are looking for several production employees (m/f/d) for an automotive manufacturer in Hamburg-Harburg in full-time. · **Your tasks**: · - Assembly of car parts · **Your profile**: · - Complet ...
-
Executive management representative
5 days ago
Crimson Solutions Newton, United StatesAbout COVENDIT Corporate Finance GmbH: · We are a privately owned and independent consulting firm for M&A in the mid-sized sector with locations in Frankfurt am Main, Munich, and Berlin. We accompany our clients from the initial consultation to the contract conclusion in the proc ...
-
Electrician for installation
3 weeks ago
Omega Innovations Newton, United StatesAbout TENT DIMENSIONS GmbH: · We specialize in all types of temporary structures and act as a full-service material provider in the event industry. · What do we offer? · Permanent employment contract · Competitive salary · Secure job and timely payment of salary · Individual trai ...
-
NebulaWorks Newton, United StatesAccount Manager (m/w/d) Berlin GULP Information Services GmbH Experienced Positions at our Locations Full-time Permanent Together. Seizing Opportunities. Write Your Next Success Story - with GULP Your Opportunity: Do you want to be part of an innovative team? Do you want to enjoy ...
Manager, Provider Contracting - Newton, United States - Cigna
Description
LOCATION: Based in Newton, MA officeThe Manager, Provider Network Contracting serves as an integral member of the Provider Contracting Team and reports to the Provider Contracting Senior Manager. 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
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: for support. Do not email 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.