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Provider Contracting Senior Advisor

2 months ago

West Bloomfield Township, Michigan, United States The Cigna Group Full time

This is a hybrid position which will require a weekly schedule of: 3 days working either in office or traveling to in-person meetings with Providers and 2 days working at home/remote.

Summary

National Contracting plays a significant role in The Cigna Group's Enterprise Affordability strategy. The LifeSOURCE Transplant Network managed by National Contracting is a key growth opportunity for Cigna and play a critical role in delivering affordability and network access for our Customers and Clients. LifeSOURCE consists of over 180 contracted facilities and represents roughly $1B in annual medical spend across US Commercial and US Government and growing. Heavy focus on controlling unit costs and trends in these contracts are critical for Cigna to achieve Affordability goals.

The Provider Contracting Senior Advisor is a key role in supporting the company's overall affordability programs, which directly address customer and client demands for lower cost and higher quality of care. This role will report to the Provider Contracting Director - LifeSOURCE and is accountable for the management of contracting and network management activities for the Northeast region.

Job Components and Deliverables:

DRIVING AFFORDABILITY AND GROWTH

  • Responsible for meeting unit cost targets, while preserving an adequate network, to achieve and maintain LifeSOURCE's competitive position
  • Partners with Medical Economics to develop and present affordability opportunities using medical, claims data, financial, and other internal/external data
  • Incorporates Industry/Competitive trends in programs/contracts
  • Partners with local markets to drive network adequacy and membership growth/persistency strategies
  • Partners with Payor Solutions operations to drive new revenue opportunities using the LifeSOURCE network across applicable lines of business
  • Contributes to the development of alternative network initiatives. Supports and provides direction to develop network analytics required for the network solution.
  • Demonstrates comprehensive knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape.

CONTRACT MANAGEMENT

  • Manages increasingly complex contracts and negotiations for transplant and advanced cellular therapy with sophisticated hospitals and physician groups for the assigned geographies.
  • Proactively builds relationships that nurture provider partnerships to support the LifeSOURCE strategy
  • Negotiates rates and terms on new and existing provider agreements
  • Creates LifeSource agreements that meet internal operational standards and external provider expectations
  • Identifies and targets new providers to bring in network
  • Incorporates contract and compliance standards into provider agreements updates including use of a variety of reimbursement methodologies (fee-for-service, capitation, case rate, DRG, outcomes based adjusted, pay for performance, RBRVS)
  • Responsible for contractual/financial performance of LifeSource provider agreements
  • Mitigates risk associated with provider performance and termination

MATRIX PARTNER ENGAGEMENT

  • Serves as single point of accountability for business relationship to Markets, Product, Clinical, Service Operations,
  • Drives education and advocacy across markets and other internal matrix partners
  • Contract language interpretation and document preparation to ensure accurate implementation and administration

Qualifications:

  • Bachelor's Degree in Finance or related field highly preferred
  • 5+ years of Commercial Contracting and Negotiating experience involving complex delivery systems and organizations
  • Strong understanding and experience with hospital, managed care, and provider business models
  • Knowledge of transplant hospital contracting is preferred
  • 25% regional travel required
  • Detailed knowledge of Affordability initiatives and medical spend categories
  • Superior problem solving, decision-making, negotiating skills, contract language and financial acumen
  • Experience in developing and managing key provider relationships, including senior executives
  • Team player with proven ability to develop strong working relationships within a fast-paced, matrix organization
  • 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.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. 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.