AVP, Provider Contract

1 month ago

Pittsburgh, Pennsylvania, United States The Cigna Group Full time
The job profile for this position is Provider Contracting Senior Manager, which is a Band 4 Management 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.

Work Location: Hybrid. 3 days (Tues, Wed, + 1 Flex Day) in Pittsburgh office.

Assistant Vice President, Network Management, Eastern PA and DE Markets

This position serves as an integral member of the Provider Contracting Team and reports to the Vice President, Network Management, Liberty Valley. 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, mentoring, and development opportunities to their direct reports.
  • Accountability for managing contracting and network management activity supporting Commercial, Medicare Advantage, and other products/initiatives (i.e. Exchange products) as applicable to market.
  • Manages increasingly complex contracts and negotiations for fee for service and sophisticated value-based reimbursements with hospitals and other providers (e.g., Hospital systems, Ancillaries, and large physician groups) across Eastern PA and DE.
  • Leads cross market and cross functional initiatives as needed.
  • 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.
  • 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.
  • Prepares, analyzes, reviews, and projects financial impact of high spend or increasingly complex provider contracts and alternate contract terms.
  • Manages key provider relationships and is accountable for 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

  • Bachelor's degree strongly preferred; 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.
  • Minimum of 5 years Provider Contracting and Negotiating experience involving complex delivery systems and organizations required.
  • Prior experience managing direct reports, developing talent, and leading project teams in a non-centralized work environment preferred.
  • Experience in developing and managing key provider relationships including senior executives.
  • Knowledge of complex reimbursement methodologies, including incentive models.
  • 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.
  • Demonstrates managerial courage and change leadership in a dynamic environment.
  • Superior problem solving, decision-making, negotiating skills, contract language and financial acumen.
  • Knowledge and use of Microsoft Office tools.
  • Able to travel as required

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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