Manager, Provider Contracting Negotiator

The job profile for this position is Provider Contracting Advisor, which is a Band 4 Senior Contributor Career Track Role.

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Are you ready to step into an exciting position that combines complex contracting and negotiation skills while working with Hospital systems, Ancillaries, and Physician groups? If so, read on to learn more 

As a Provider Contracting Negotiator Manager at Cigna Healthcare, you'll be an integral member of the Provider Contracting Team and report to the AVP of Provider Contracting. In this role, you will assist in developing the strategic direction and managing day-to-day contracting and network management activities for a local territory. Your work will directly contribute to helping patients access high-quality, affordable healthcare—making a meaningful difference in the lives of individuals and families in your community.

Location: You must reside in the Mid-Atlantic market: Maryland, DC, or Virginia.

How you'll make a difference:

• Manage complex contracting and negotiations for fee-for-service and value-based reimbursements with hospitals and other providers (Hospital systems, Ancillaries, and large physician groups).

• Build relationships that nurture provider partnerships and seek broader value-based business opportunities to support the local market strategy. Manage key provider relationships and is accountable for critical interface with providers and business staff. 

• Manage key provider relationships, accountable for critical interface with providers and business staff. 

• Initiate and maintain 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.

• Manage strategic positioning for provider contracting, develop networks, and identify opportunities for greater value-orientation and risk arrangements.

• Contribute to the development of alternative network initiatives. Support and provide direction to develop network analytics required for the network solution.

• Work to meet unit cost targets while preserving an adequate network to achieve and maintain Cigna's competitive position.

• Create and manage initiatives that improve total medical cost and quality.

• Drive change with external provider partners by assessing clinical informatics and offering consultative expertise to assist with total medical cost initiatives.

• Prepare, analyze, review, and project the financial impact of larger or complex provider contracts and alternate contract terms.

• Create "HCP" agreements that meet internal operational standards and external provider expectations. Ensure the accurate implementation and administration through matrix partners. 

• Assist in resolving elevated and complex provider service complaints. Research problems and negotiate with internal/external partners/customers to resolve highly complex and/or escalated issues.

• Demonstrate knowledge of providers in an assigned geographic area through understanding interrelationships and the competitive landscape.

• Responsible for accurate and timely contract loading and submissions. Interface with matrix partners for network implementation and maintenance.

• Provide guidance or expertise to less experienced specialists as needed.

Qualifications: 

• Bachelor's degree or significant industry experience will be considered.

• 3+ years of experience within a Healthcare environment required.

• 3+ years of Provider Contracting and Negotiating experience involving complex delivery systems and organizations.

• Strong skills in solving problems, making decisions, negotiating, and understanding contracts and financial details.

• Strong analytical skills with Excel. Able to manipulate, index, and query data in multiple views and formats.

• Confident communicator with experience presenting to groups and influencing others.

• Skilled at building and maintaining strong partnerships with external providers.

• Well-versed in complex payment models, including performance-based incentives.

• Collaborative team player who thrives in fast-paced, customer-focused environments and works well across different teams.

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.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

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