Job Description

Provider Contracting Network Management

This role serves as an integral member of the Provider Contracting Team and reports to the Senior Director, Provider Contracting. It 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.
• 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.
• Contributes to the development of alternative network initiatives.
• Works to meet unit cost targets, while preserving an adequate network.
• Creates and manages initiatives that improve total medical cost and quality.
• Drives change with external provider partners.
• Prepares, analyzes, reviews, and projects financial impact of larger or complex provider contracts.
• Creates healthcare provider agreements.
• Assists in resolving elevated and complex provider service complaints.
• Manages key provider relationships.
• Demonstrates knowledge of providers in an assigned geographic area.
• Responsible for accurate and timely contract loading and submissions.
• 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's degree. MBA or MHA preferred.
• 3+ years experience in Provider Contracting/Provider Network Management and negotiating involving complex delivery systems and organizations, required.
• 3+ years experience in Healthcare, Health Insurance, Managed Care, 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 an ability to maneuver effectively in a changing environment.
• Superior problem solving, decision-making, negotiating skills, contract language and financial acumen.
• Knowledge and use of Microsoft Office tools.

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.

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.

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.

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