- Developing and managing talent of up to 7 direct reports
- Leading network development within local market and cultivating key provider partner relationships in order to drive optimal performance on Stars, risk adjustment, utilization management, and overall financial performance.
- Leading market level projects and strategies related to provider engagement.
- Preparing for and facilitating external physician meetings and value based contract administrative meetings (JOCs).
- Preparing for and facilitating a monthly financial review to senior management, including but not limited to financials, quality and coding progress, action plans, reviews/evaluations and any accompanying analysis.
- Driving excellence in compliance, consistency in approach to being the partner of choice for providers, and approach to driving growth, performance and affordability in provider network.
- Developing and executing strategic plans on growth, development, and vision for each provider group, bringing it together for entire market.
- Responsible for maintaining compliance to CMS and company policies and guidelines.
- Leading cross-market, cross-functional initiatives and performing special projects and other duties as assigned by leadership.
- Growing the MA Business: The Provider Performance Manager is accountable for the growth of the assigned (specify domain here - sub-market, provider groups or territories) in terms of financial profitability, increase in provider network and membership
- Delivering our Services: The Provider Performance Manager is accountable for the exceptional delivery of services in the assigned (specify domain here - sub-market, provider groups or territories) as evidenced by physician and member satisfaction, improvements on Star Rating and NPS score.
- Managing our Costs: The Provider Performance Manager ensures the affordability of services in the assigned (specify domain here - sub-market, provider groups or territories) by effective control of various cost levers like Med/OPEX.
- Developing our People: The Provider Performance Manager provides leadership and management across all the teams in the assigned (specify domain here - sub-market, provider groups or territories). He/she ensures the effective coaching and management of these teams.
- Collaborating with our Partners: The Provider Performance Manager seamlessly collaborates with all applicable partners to 'solve for Cigna', and may lead cross-functional or cross-market initiatives that improve service delivery within the business.
- Location: Must be located in the South Florida Market; Southeast, Treasure Coast, and Southwest Markets
- Bachelor's degree strongly preferred, Master's degree; MBA or other preferred
- 6+ years of direct provider-facing experience or direct health plan experience with STARS, HEDIS, Risk Adjustment and medical expense reduction, specific to Medicare Advantage required
- Ability and track record of thinking strategically, applying an enterprise mindset and business acumen resulting in meeting or exceeding goals in growth and profitability
- Keen customer focus and ability to develop strong, lasting relationships with providers resulting in deeper collaboration and satisfaction
- Capacity for leading initiatives and influencing people on cross-functional teams; ability to drive transparency and accountability, and learn the strengths and weaknesses of the team so as to inform leadership to put people in a position to succeed
- Ability to develop strong relationships across multiple levels of the organization -Effective communicator-
- Technology Proficient – Microsoft Outlook, Excel, PowerPoint, Excel, and Word
- Direct experience with health plan operations, preferably specific to government sponsored health plans
Medicare Provider Performance Manager - Miramar, United States - The Cigna Group
Description
The job profile for this position is Network Operations Manager, which is a Band 4 Management 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.
Role Summary
The Provider Performance Enablement (PPE) Manager is a key member of a cross-functional, collaborative organization (which includes Market Provider Performance, Sales, Health Services, Clinical, Stars & Risk Adjustment, Finance, Marketing, Cross-Segment Contracting, Provider Relations, and Network Development & Solutions). Reporting to the Provider Performance Senior Manager/Operations Director/Operations Senior Director (Market President), the Provider Performance Manager ensures the effective management of the performance outcomes of the provider network.
The Provider Performance Manager's responsibilities include:
Role Components
All market team members contribute to the growth and profitability of the
Medicare Advantage business in their market in the following aspects:
Qualifications
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.