Provider Contracting Director – Transplant

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $106.4k - $177.3k / year

⏰ Full Time

🔴 Lead

👔 Director

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The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1982

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare • 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

• 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 that 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 as needed for provider meetings and negotiations

🎯 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 • Internet connection through cable broadband or fiber optic service with at least 10Mbps download/5Mbps upload when working at home • Preferred: Transplant, stem-cell, or advanced cellular therapy contracting experience • Preferred: Experience negotiating bundled or case-rate arrangements for complex episodes of care • Preferred: Knowledge of commercial hospital contracting, network affordability, and provider incentive programs • Preferred: Experience with contract modeling, redlining, network analytics, and strategic provider negotiations • Preferred: Familiarity with internal healthcare payer operations and cross-functional contract implementation • Preferred: Established knowledge of provider markets in the Northeast

🏖️ Benefits

• Annual bonus plan eligibility • Medical insurance • Vision insurance • Dental insurance • 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 • Cable broadband or fiber optic internet requirement for home working