Provider Contracting Manager manages the activities of the contracting staff that prepare and maintain contracts and the contracts database system for a health plan network. Responsible for negotiating with facilities joining the health network and setting rates. Being a Provider Contracting Manager oversees network reporting requirements to ensure compliance with regulatory agencies, and to produce accurate and relevant reporting of data. Trains and develops staff. Additionally, Provider Contracting Manager requires a bachelor's degree. Typically reports to a head of a unit/department. The Provider Contracting Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Extensive knowledge of department processes. To be a Provider Contracting Manager typically requires 5 years experience in the related area as an individual contributor. 1 to 3 years supervisory experience may be required. (Copyright 2024 Salary.com)
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This is a hybrid position which will require a weekly schedule of: 3 days working either in office or traveling to in-person meetings with Providers and 2 days working at home/remote.
Summary
National Contracting plays a significant role in The Cigna Group's Enterprise Affordability strategy. The LifeSOURCE Transplant Network managed by National Contracting is a key growth opportunity for Cigna and play a critical role in delivering affordability and network access for our Customers and Clients. LifeSOURCE consists of over 180 contracted facilities and represents roughly $1B in annual medical spend across US Commercial and US Government and growing. Heavy focus on controlling unit costs and trends in these contracts are critical for Cigna to achieve Affordability goals.
The Provider Contracting Senior Advisor is a key role in supporting the company's overall affordability programs, which directly address customer and client demands for lower cost and higher quality of care. This role will report to the Provider Contracting Director - LifeSOURCE and is accountable for the management of contracting and network management activities for the Northeast region.
Job Components and Deliverables:
DRIVING AFFORDABILITY AND GROWTH
Responsible for meeting unit cost targets, while preserving an adequate network, to achieve and maintain LifeSOURCE’s competitive position
Partners with Medical Economics to develop and present affordability opportunities using medical, claims data, financial, and other internal/external data
Incorporates Industry/Competitive trends in programs/contracts
Partners with local markets to drive network adequacy and membership growth/persistency strategies
Partners with Payor Solutions operations to drive new revenue opportunities using the LifeSOURCE network across applicable lines of business
Contributes to the development of alternative network initiatives. Supports and provides direction to develop network analytics required for the network solution.
Demonstrates comprehensive knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape.
CONTRACT MANAGEMENT
Manages increasingly complex contracts and negotiations for transplant and advanced cellular therapy with sophisticated hospitals and physician groups for the assigned geographies.
Proactively builds relationships that nurture provider partnerships to support the LifeSOURCE strategy
Negotiates rates and terms on new and existing provider agreements
Creates LifeSource agreements that meet internal operational standards and external provider expectations
Identifies and targets new providers to bring in network
Incorporates contract and compliance standards into provider agreements updates including use of a variety of reimbursement methodologies (fee-for-service, capitation, case rate, DRG, outcomes based adjusted, pay for performance, RBRVS)
Responsible for contractual/financial performance of LifeSource provider agreements
Mitigates risk associated with provider performance and termination
MATRIX PARTNER ENGAGEMENT
Serves as single point of accountability for business relationship to Markets, Product, Clinical, Service Operations,
Drives education and advocacy across markets and other internal matrix partners
Contract language interpretation and document preparation to ensure accurate implementation and administration
Qualifications:
Bachelor’s Degree in Finance or related field highly preferred
5 years of Commercial Contracting and Negotiating experience involving complex delivery systems and organizations
Strong understanding and experience with hospital, managed care, and provider business models
Knowledge of transplant hospital contracting is preferred
25% regional travel required
Detailed knowledge of Affordability initiatives and medical spend categories
Superior problem solving, decision-making, negotiating skills, contract language and financial acumen
Experience in developing and managing key provider relationships, including senior executives
Team player with proven ability to develop strong working relationships within a fast-paced, matrix organization
Knowledge and use of Microsoft Office tools
This role is also anticipated to be eligible to participate in an annual bonus plan.
We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.