- Assist with relationship management and contracting strategy for complex health system providers.
- Builds relationships that nurture provider partnerships and seeks broader value-based business opportunities to support local markets in their strategies.
- 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, Affordability and Service. Represents Network Contracting in work groups involving various affordability initiatives.
- Works closely with Legal on pending arbitrations involving assigned providers, if applicable.
- 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 some key provider relationships and is accountable for critical interface with providers and business staff.
- Demonstrates knowledge of provider and market dynamics, emerging trends, challenges and opportunities through understanding the interrelationships as well as the competitive landscape; Aggregates information to update markets on a regular basis.
- Bachelor's degree, strongly preferred; 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.
- Five years or more years in contracting and negotiating experience involving complex delivery systems and organizations required; specifically needing extensive experience in negotiating commercial facility agreements for fee for service and fee for value arrangements.
- Excellent project management and organizational skills
- 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 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.
- Excellent project management and organizational skills
- Knowledge and use of Microsoft Office tools.
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Director, Provider Network Management - Clayton, United States - The Cigna Group
Description
The job profile for this position is Provider Contracting Senior 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 recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply
Our people make all the difference in our success.
LOCATION: Hybrid/Remote position aligned to the Missouri. Requires one day a week in an Office/Provider site visits. Must reside in Kansas City or St. Louis
The Director, Provider Network Management position reports to the Mid America market VP of Network Management. This role assists in developing, coordinating and socializing the strategic direction and management of contracting for large, complex providers and network management initiatives in the Mid America market. Works closely with the Network VP on various initiatives.
DUTIES AND RESPONSIBILITIES
POSITION REQUIREMENTS
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.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.
Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.
