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The Medicare Advantage Senior Network/Contracting Manager will report to the Mid-Atlantic/Pennsylvania Network Operations Director, and will be a key member of a cross-functional, cross-collaborative team, including Network Operations, Sales, Health Services, Coding, Finance, Marketing, Stars, and Commercial Contracting.The Network/Contracting Senior Manager is responsible for providing day to day management and leadership of assigned Network Operations team in the a territory. Responsible for effective management of Medicare Advantage provider network in assigned territory, to include: financial performance, quality/Medicare Star rating program initiatives, provider data accuracy, trend analysis, and provider engagement (particularly, PCPs and key hospital/physician/physician organization partners). Responsible for the development and cultivate key provider partner relationships. Responsible for developing and executing strategic plans on growth, development, and vision for assigned territory, and for expanding into other potential markets. Manages the overall Medicare Advantage contracting strategy for the assigned territory and work closely with the aligned commercial contracting team(s).Duties and Responsibilities:
Responsible for the oversight of network development and management of assigned regions/states.
Responsible for effective management of Medicare Advantage provider network in assigned territory, to include: financial performance, quality/Medicare Star rating initiatives, provider data accuracy, trend analysis, compliance, and provider engagement (particularly, PCPs and key hospital/physician/physician organization partners).
Responsible for developing and executing strategic plans on growth, development, and vision for assigned territory, including oversight of network expansion activities
Manages complex contracting and negotiations for fee for service and value-based reimbursements with large physician groups, ancillary providers and hospitals, as applicable.
Prepares and analyzes financial impact of larger or complex physician and ancillary contracts.
Manages strategic positioning for provider contracting, develops networks and identifies opportunities for greater value-orientation and risk arrangements.
Lead market initiatives and perform special projects and other duties as assigned by leadership.
Responsible for accurate and timely contract loading and submissions and interface with matrix partners for network implementation and maintenance.
Manage agreements that meet internal operational standards and external provider expectations. Ensure accurate implementation and administration through matrix partners.
Develop and maintain strong working relationships with matrix partners
Leads a team that is responsible for contracting (FFS & Value based), provider relations, physician engagement and management of value based and other incentive programs
Attract, recruit, hire, develop, mentor, coach and retain top talent. Including development of near- and long term business-driven strategic talent plan that ensures continuous, high quality, diverse talent to enable execution of the Medicare growth strategy.
Qualifications /Competencies:
Bachelor degree or higher preferred. Significant industry experience will be considered in lieu of a degree
3-5 plus years demonstrated achievement and progressive responsibilities in the area of provider network operations or health plan operations
5+ years of related management experience
5+ years contracting and negotiating experience involving complex healthcare delivery systems and organizations required
Knowledge of Medicare Advantage contracting involving complex delivery systems, value based contracting, and risk reimbursement
Ability to work independently and handle multiple priorities
Strong analytical and technical aptitude
Superior problem solving, decision-making, negotiating skills, priority-setting and financial acumen.
Team player with proven ability to develop strong working relationships within a fast-paced, matrix organization.
The ability to influence provider audiences through strong written and verbal communication skills.
Knowledge and use of Microsoft Office tools.
About CignaCigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation.When you work with Cigna, you’ll enjoy meaningful career experiences that enrich people’s lives while working together to make the world a healthier place. What difference will you make? To see our culture in action, search #TeamCigna on Instagram.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: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.
