Provider Contracting Director – West Region

Job not on LinkedIn

🔥 0 minutes ago

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

• Overall accountability for ensuring that field contractors comply with contracting standards, including use of current core contracts, reimbursement standards, network and contract policy, and the provider contract escalation and review process • Provide guidance and support to field contractors on national standards and use of the Contract Management System • Support field contractors on non-standard issues and work closely with the National Contracting Standards & Policy team on policy, language, and "ability to administer" issues as well as on reporting and compliance with the exception review process • Work with contractor to develop appropriate response and/or contractual language that does not jeopardize Cigna's contracts with employers, internal policies or standards • Ensure required documentation is complete prior to signature by RVP or Market Lead • Facilitate internal and external audit requirements • Ensure members of field contracting team receive appropriate and continuous training in all aspects of contracting standards, including use of current, appropriate, core contract templates; preferred reimbursement standards; national network and contracting policy; and the standard contract process • Ensure understanding and compliance by field contractors with the standard contract process and review of all exceptions to "ability to administer", financial objectives, policies, and language • Provide consultative support to field contractors on contracting, policy and procedural issues as needed • Support field contracting in maximizing use of the system • Ensure all new employees receive the appropriate training • Monitor Contract Manager usage in accordance with the established guidelines • Develop contract language and rate exhibit options for field use • Collaborate with other RDs, Network Analytics Unit and other national functions such as claim operations, medical management, and legal to share best practices and devise creative solutions to complex problems • Work with national groups to continually review and improve the SARU (Satisfactory, Acceptable, Reviewable and Unacceptable) contract standards for all contract types • Partner closely with US Medical Network Contracting Readiness to ensure policies and standards are communicated to the field staff appropriately • Work closely with Standards & Policy Committee to identify and resolve issues requiring cross-functional solutions, policymaking and communication • Provide input and support to national projects (e.g. new product roll-outs, regulatory compliance initiatives, etc.) requiring contract content reviews, language compliance assessments and/or network participation assessments • Work with local contract teams on language remediation initiatives.

🎯 Requirements

• 7+ years in Medical Contracting, Negotiating and Provider Services • Ability to foster collaboration, value others perspectives and gain support and buy-in for organizational proposals • Matrix management skills • Ability to drive and lead an organization through change • Excellent interpersonal and relationship management skills • Excellent oral, written and presentation skills required • Strong collaboration, negotiation and leadership skills • Strong organizational and analytical skills that result in conclusive recommendations • Ability to think critically with respect to improvement of end-to-end business process

🏖️ Benefits

• medical, vision, dental, and well-being and behavioral health programs • 401(k) • company paid life insurance • tuition reimbursement • a minimum of 18 days of paid time off per year • paid holidays • leaves of absence