Provider Contracting Advisor

🕒 4 days ago

🧀 Wisconsin – Remote

🧀 Wisconsin – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

Apply Now

Find Similar Remote Jobs

Receive Emails For Remote Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1982

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare Insurance • Pharmaceuticals

The Cigna Group is a global health company committed to improving the health and vitality of its clients, customers, and patients. With its two divisions, Cigna Healthcare and Evernorth Health Services, the company focuses on enhancing quality of life through healthcare services and pharmacy benefits management. The Cigna Group is dedicated to ethical practices in healthcare and artificial intelligence, and strives to create positive change in the healthcare system. It also emphasizes its Environmental, Social, and Governance (ESG) responsibilities, aiming to impact health equity and foster innovation in healthcare delivery.

📋 Description

• Manage complex fee-for-service and value-based contracting and negotiations with large physician groups, ancillaries, and hospital systems. • Lead key market contracting strategy projects with responsibility for managing direct reports as assigned. • Build and maintain strong provider relationships to support network growth and value-based business opportunities. • Coordinate closely with matrix partners (i.e., Claims, Medical Management, Credentialing) to ensure aligned execution. • Develop strategic network positions, identify value-oriented and risk-based opportunities, and contribute to alternative network initiatives and analytics. • Work to meet unit cost targets while maintaining an adequate, competitive provider network. • Design and manage initiatives to improve medical cost and quality, offering consultative guidance informed by clinical informatics. • Prepare, review, and project the financial impact of large or complex provider contracts and alternative terms. • Create, implement, and ensure operational accuracy of HCP agreements through effective cross-functional collaboration. • Lead resolution of escalated provider issues and manage key provider relationships with deep knowledge of the local market landscape including contract loading and maintenance.

🎯 Requirements

• 3-5+ years of healthcare provider contracting and negotiating experience involving complex physician groups and ancillaries • Background in managed care, healthcare, or health insurance, including commercial contracting • Proven leadership experience, including mentoring and guiding others • Strong provider relationship management skills and success developing long-term partnerships • Knowledge of complex reimbursement methodologies, including incentive-based models (strongly preferred) • Deep understanding of hospital, managed care, and provider business models with the ability to influence sales and provider audiences • Exceptional presentation and communication skills, including the ability to build internal relationships in a fast-paced, matrixed organization • Customer-centric approach, strong interpersonal skills, and confidence in navigating change • Strong problem-solving, decision-making, negotiation, contract interpretation, and financial analysis skills • Proficiency in Microsoft Office

🏖️ Benefits

• Health insurance • 401(k) matching • Flexible work hours • Paid time off