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Regional Medicare Provider Contracting Senior Manager

3 months ago

Springfield, Illinois, United States The Cigna Group Full time

The Regional Medicare Provider Contracting Senior Manager - Midwest serves as an integral member of the Network Development and Solutions Team and reports to the Medicare Provider Contracting Regional Vice President. This role is a key contributor to the development of the strategic direction of assigned markets and is accountable for the management of value-based and fee-for-service contracting and network management activities for multiple local geographies.

DUTIES AND RESPONSIBILITIES

  • Directly manages a contracting team and 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 Cigna's 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, local market provider engagement, claims operations, clinical, Legal, analytics, compliance, sales, and provider relations.
  • Manages strategic positioning for provider contracting, develops networks, and identifies and acts upon opportunities for greater value-orientation.
  • 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 and marketable network, to achieve and maintain Cigna's competitive position.
  • Identify and manages initiatives that improve total medical cost and quality.
  • 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 Provider agreements (ie: Hospital systems, ancillaries, and physician groups) 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. Research 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

POSITION REQUIREMENTS

  • Location: Individual must be located in Illinois or Missouri (or surrounding states, open to travel).
  • Should possess a bachelor's 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. Medicare Advantage experience required.
  • Experience with Physician, Hospital and Ancillary group contracting and negotiations.
  • Prior experience managing direct reports.
  • 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 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 127, ,100 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. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll 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.