Director, Network Management

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🕒 3 dias atrás

🥔 Idaho – Remoto

🥔 Idaho – Remote

⏰ Tempo Integral

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The Cigna Group

SiteLinkedInTodas as Vagas

10.000+ funcionários

Fundada em 1982

⚕️ Seguro de Saúde

💊 Farmacêutico

Healthcare Insurance • Pharmaceuticals

O Grupo Cigna é uma empresa global de saúde comprometida em melhorar a saúde e vitalidade de seus clientes, consumidores e pacientes. Com suas duas divisões, Cigna Healthcare e Evernorth Health Services, a empresa foca em melhorar a qualidade de vida através de serviços de saúde e gestão de benefícios farmacêuticos. O Grupo Cigna é dedicado a práticas éticas em saúde e inteligência artificial, e se esforça para criar mudanças positivas no sistema de saúde. Também enfatiza suas responsabilidades Ambientais, Sociais e de Governança (ESG), visando impactar a equidade em saúde e promover a inovação na prestação de serviços de saúde.

Descrição

• Manages complex contracting and negotiations for fee for service and value-based reimbursements with hospitals and other providers (e.g., Hospital systems, Ancillaries, and large physician groups). • May lead a team with direct reports. • Point person for complex projects related to contracting strategy in the market. • Builds relationships that nurture provider partnerships and seeks broader value-based business opportunities to support the local market strategy. • Initiates 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 opportunities for greater value-orientation and risk arrangements. • Contributes to the development of alternative network initiatives. • Supports and provides direction to develop network analytics required for the network solution. • Works to meet unit cost targets, while preserving an adequate network, to achieve and maintain Cigna's competitive position. • Creates and manages initiatives that improve total medical cost and quality. • Drives change with external provider partners by assessing clinical informatics and offering consultative expertise to assist with total medical cost initiatives. • Prepares, analyzes, reviews, and projects financial impact of larger or complex provider contracts and alternate contract terms. • Creates “HCP” agreements that meet internal operational standards and external provider expectations. • Ensures the accurate implementation, and administration through matrix partners. • Leads in resolving elevated and complex provider service complaints. • Researches problems and negotiates with internal/external partners/customers to resolve highly complex and/or escalated issues. • Manages key provider relationships and is accountable for critical interface with providers and business staff. • Demonstrates 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.

🎯 Requisitos

• Should possess a bachelor degree; 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. • 5+ years contracting and negotiating experience involving complex delivery systems and organizations required. • Significant experience leading and mentoring others. • Experience in developing and managing key provider relationships. • Knowledge of complex reimbursement methodologies, including incentive based models strongly preferred. • Demonstrated experience in seeking out, building and nurturing strong external relationships with provider partners. • Intimate understanding and experience with hospital, 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. • Experience with formal presentations. • Customer centric and interpersonal skills are required. • Demonstrates managerial courage as well as an ability to maneuver effectively in a changing environment. • Superior problem solving, decision-making, negotiating skills, contract language and financial acumen. • Knowledge and use of Microsoft Office tools.

🏖️ Benefícios

• Health insurance • 401(k) matching • Paid time off • Flexible work arrangements • Professional development opportunities