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    Manager, Provider Contracting - Raleigh, United States - The Cigna Group

    The Cigna Group
    The Cigna Group Raleigh, United States

    3 weeks ago

    Default job background
    OTHER
    Description
    The 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 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: Based in Raleigh or Charlotte, NC office

    Medicare Advantage position

    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 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.
    • 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.

    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 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

    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.

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