Provider Contracting Director – Transplant

Job not on LinkedIn

🔥 9 minutes ago

🇺🇸 United States – Remote

💵 $106.4k - $177.3k / year

⏰ Full Time

🔴 Lead

👔 Director

👻 Ghost score 0%

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The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛡️ Insurance

Healthcare • Insurance

The Cigna Group is a global health services company that provides medical, dental, pharmacy, behavioral and supplemental insurance products and benefits to individuals, families, employers, brokers, providers and Medicare beneficiaries. It offers employer-sponsored group plans, individual and family plans (including Open Enrollment offerings), Medicare, international health insurance covering more than 200 countries, and digital member services through the myCigna platform (including telehealth and claims management). Its products are delivered through operating subsidiaries such as Cigna Health and Life Insurance Company and other regional affiliates.

📋 Description

• Lead complex contract negotiations with hospitals, transplant centers, physician groups, and advanced cellular therapy providers across the Northeast • Negotiate reimbursement rates, financial terms, contract language, renewals, amendments, and new provider agreements • Develop agreements using fee-for-service, case rates, bundled payments, DRGs, and value-based arrangements • Manage financial and operational performance of assigned provider agreements, including unit-cost targets and affordability initiatives • Evaluate claims, medical, financial, and market data to identify contracting opportunities, assess financial impact, and support negotiation strategies • Maintain understanding of the Northeast provider landscape, competitive dynamics, network gaps, market relationships, and industry trends • Identify and recruit providers to strengthen network access, adequacy, quality, and geographic coverage • Build relationships with provider executives and contracting leaders while addressing escalations, performance concerns, and potential contract terminations • Interpret contract language and coordinate implementation and administration of negotiated terms • Partner with Medical Economics, Clinical, Product, Operations, local market teams, Legal, Compliance, and other stakeholders on network strategies • Serve as primary point of accountability for assigned provider relationships and regional contracting initiatives • Manage multiple negotiations and deliverables simultaneously in a complex, highly matrixed environment • Travel within the Northeast territory for provider meetings and negotiations as needed

🎯 Requirements

• Bachelor’s degree or equivalent relevant professional experience • At least five years of commercial healthcare contracting and negotiation experience involving hospitals, health systems, large physician groups, or other complex delivery organizations • Experience negotiating reimbursement, financial terms, and contractual language with sophisticated provider organizations • Strong understanding of hospital, managed-care, and provider business models • Experience independently managing a substantial portfolio of active contracts and concurrent negotiations • Strong financial acumen, including interpreting reimbursement models, claims information, contract performance, and financial analyses • Ability to develop and maintain relationships with senior provider executives and internal business leaders • Excellent negotiation, problem-solving, decision-making, organization, and written and verbal communication skills • Ability to work independently, shift priorities quickly, and deliver results in a fast-paced matrix organization • Proficiency with Microsoft Excel, Word, PowerPoint, and related business tools • Willingness and ability to travel within the Northeast territory as needed

🏖️ Benefits

• Annual bonus plan eligibility • Medical benefits • Vision benefits • Dental benefits • Well-being and behavioral health programs • 401(k) • Company-paid life insurance • Tuition reimbursement • Minimum of 18 days of paid time off per year • Paid holidays • Leaves of absence • Remote work arrangement with required cable broadband or fiber optic internet service at speeds of at least 10Mbps download/5Mbps upload