ONPT Provider Contracting Director

1 month ago

Remote, Oregon, United States The Cigna Group Full time

ENCORE POSITION

Provider Contracting Director

The role manages a team that executes on sustained growth, revenue and earnings strategy while ensuring compliance with State and Federal regulations. This role has responsibility to grow operational excellence across several teams within the Out of Network Protection Team (ONPT). They include Voluntary Operations, NSA Operations and the Service Team. This role has the responsibility to identifying and implementing new initiatives to control total medical costs.

In addition the role has direct Vendor Management responsibilities across several relationships that directly effects Cigna's total cost of care. The role has broad matrix management requirements, including Legal, Finance, Claim, Product, Sales, Contracting, and National Appeals.

  • Overall Program Savings – Increase annualized savings vs baseline due to national programs, focusing on Out of Network (OON) claims
  • Strategic Roadmap - Develop innovative, best-in-class solutions with existing and potential new external vendor partners to address cost issues
  • Enterprise Mindset – Drive consistency and value across US Commercial and US Government lines of business
  • Vendor Management – Accountability for operational performance of large vendor repricing contracts related of OON Claims management.
  • Design and Implementation – Partner with internal business teams to understand requirements, timeframes, and technology considerations and other constraints that must be considered to deliver on new objectives. This includes unique capabilities roadmaps for emerging products (government, individual, alt network)
  • Data-Driven Decisions – Continue to develop robust reporting and analytics capabilities in support of changing affordability demands and operational landscape.
  • OON Claims Operations - Mature operational approach to managing OON claims across internal and vendor processes to insure consistency and transparency.
  • Claims Accuracy - Improve efficiency related to claims flow between Service Operations, NPCC, and Vendors
  • Policy - Create policy recommendations and persuade matrix partners to adopt (i.e., service ops, medical policy, contracting and product solutions)
  • Best Practices - Optimization of existing practices and development of new ones to quickly address areas of focus, maintaining and extending the business unit's superior outcomes
  • Attract and Develop Talent - Focus on leadership continuity, including support development of current staff while recruitment of additional talent
  • Product and Markets – Regular engagement with local markets on performance of national programs and value to Clients
  • Matrix Partner Management - Cultivate mutually beneficial relationships of with a network of Matrix Partners that will support Cost Containment goals

QUALIFICATIONS:

  • 10+ years industry experience solving business problems through application of innovative analytics, knowledge of healthcare industry dynamics and emerging technologies
  • Preferred extensive experience in healthcare industry with out-of-network specific experience a plus
  • 10+ years directly supporting claims pricing
  • Proven track record for success in building out best-in-class capabilities at the enterprise level identifying, evaluating and deploying successful partnership strategies.
  • Experience managing high degree of change and complexity across organization and portfolio
  • 10+ years managing external partners and superior knowledge of competitive capabilities
  • Advanced degree in business, healthcare or quantitative field with an emphasis on business applications and financial impacts a plus

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.

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.

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