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AVP, Provider Network Management
3 months ago
LOCATION: HYBRID position aligned to the Southern CA market. Must reside in Los Angelis/Orange County/Glendale, CA
Will require a weekly schedule of: several days per week working at Home AND several days per week working either in Office or Travel out to in-person meetings with Providers.
The AVP, Network Management serves as an integral member of the Network Management & Affordability Team and reports to the VP, Network Management. This role is a key contributor to the development of the strategic direction and is accountable for the management of contracting and network management activities for multiple local geographies.
DUTIES AND RESPONSIBILITIES
Directly manages a contracting team or geography, providing leadership and mentoring to their direct reports.
Manages increasingly complex contracts and negotiations for fee for service and sophisticated value-based reimbursements with hospitals and other providers for both Cigna's US Commercial and Medicare product lines (e.g., Hospital systems, Ancillaries, and large physician groups) for one or more geographies.
Proactively builds relationships that nurture provider partnerships and seeks broader value-based business opportunities to support the local market strategy.
Initiates, nurtures 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 and acts upon opportunities for greater value-orientation and risk arrangements.
Identifying and implementing alternative network initiatives. Supports and provides direction to develop network analytics required for the network solution.
Responsible for meeting unit cost targets, while preserving an adequate network, to achieve and maintain Cigna's competitive position.
Identify 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 high spend or increasingly complex provider contracts and alternate contract terms.
Creates and / or oversees the development of 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 comprehensive 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.
Partner with Regulatory Affairs to ensure all network filings are timely and accurate.
POSITION REQUIREMENTS
Should possess a bachelor degree; preferably in the areas of Finance, Economics, Healthcare or Business related. MBA or MHA preferred.
5+ years Contracting and Negotiating experience involving complex delivery systems and organizations required
Experience with Physician, Hospital and Ancillary group contracting and negotiations
Experience negotiating delegated, capitated agreements in California.
Knowledge of HMO pay-for-performance and IHAs role in the industry.
Experience with Healthcare - Commercial
Prior experience managing direct reports and leading project teams in a non-centralized work environment
Experience in developing and managing key provider relationships including senior executives
Knowledge of complex reimbursement methodologies, including incentive based models required
Demonstrated experience in seeking out, building and nurturing strong external relationships with provider partners
Intimate understanding and experience with larger, more complex integrated delivery systems, 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 and change leadership in a dynamic environment
Superior problem solving, decision-making, negotiating skills, contract language and financial acumen
Proficient with Microsoft Office (Word, Excel, PowerPoint, Outlook)
Proficient in contract building software such as Contract Manager
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.
For this position, we anticipate offering an annual salary of 106, ,300 USD / yearly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
We want you to be healthy, balanced, and feel secure. Thats why youll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, youll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group .
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.
