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Provider Contracting Senior Manager

4 months ago

Houston, United States The Cigna Group Full time

Role Summary

The Provider Contracting Senior Manager will have oversight of a region of facility networks and will be responsible for its contract performance.  This Senior Manager will be responsible for directing a team of negotiators to manage all rate renewals and contract maintenance activities.  This Senior Manager will collaborate with the other Regional Senior Managers to develop facility affordability action plans, align with medical contracting as well as partner with large regional and select national systems.   In addition, the Senior Manager will contribute to the overall Network Strategy by delivering strategic projects related but not limited to implementation of strategic initiatives regarding Network Solutions and Innovative Contracting to enhance provider supply and demand as well as the evolution of our reimbursement models.

Role and Responsibilities

  • Oversee system contract performance teams to rate renewal targets, unit cost and overall claim trend targets are met.

  • Utilize internal data such as claims, completed negotiations and network composition along complete and external benchmarking to develop a comprehensive reimbursement strategy that drives affordability while improving access and quality of care. 

  • Coordinate with Network Informatics, Finance, and other Network Managers to develop and monitor the facility budget for new and existing regional facility systems as well as develop a competitive intel process leveraging transparency data as well as Medicare and Medicaid pricing.

  • Collaborate with Network Directors, Medical Directors, and product leadership to create new coverage policies for innovative reimbursement structures and new product designs as well as implement product specific networks curated to drive quality and affordability.

  • Execute partnership plans with facility systems as well as construct a united negotiation strategy with our Medical Commercial and Medicare contracting and Network Strategy Leadership.

  • Design innovative contract solutions such as measurement-based care, case rates or preferred provider networks, performance guarantees, as well product specific networks and rates.

  • Enhance the Facility Center of Excellence Program along with with Network Medical Director and Clinical Operations which include but not limited to developing a performance meeting process which will increase the utilization and expand the number of Facility Center of Excellences.

  • Work with other Contract Managers to build a contract management system and oversee contract governance for facility contracting templates and protocols.

  • Increase provider satisfaction through provider experience improvement initiatives such as decreasing turnaround times and streamlining facility onboarding and contract maintenance.

  • Set facility targets and oversee Team Monthly Operating Reports (MOR) and assist in maintaining Department MOR to identify trends and highlight successes as well as barriers to success.

  • Meet regularly with direct manager and conduct skip levels to mentor, guide and develop needed skills for their roles as well as assist with complex issues and/or negotiations.

Qualifications:

  • Master’s degree strongly preferred and 6+ years of contracting experience.

  • Intimate knowledge of managed care operations and facility network management in behavioral and/or medical with experience with commercial and government products, such as Medicare, Medicaid and or Individual and Family Plans.

  • Skills in developing preferred provider networks, centers of excellences and alternative contract solutions, such as measurement-based care, case rates and shared savings.

  • Strong strategic acumen, including strategic thought, creation, and execution.

  • Adept analytical, project management skill, superior problem solving and decision-making skills.

  • Excellent management and leadership skills.

  • Enterprise thinker with proven ability to influence across a matrix environment.

  • Ability to develop relationships across all levels of the organization, as well as externally.

  • Technical/Functional expertise: provider contracting, provider relations and negotiation.

  • Exceptional service experience knowledge and skills.

  • Proficient writing and verbal communication skills and experience with formal presentations.

  • Capable of working independently and be self-directed.