Living Well Health Center
Manager, Provider Contracting - Ancillary/Hospital/Physician Group - Walnut Cree
Living Well Health Center, Walnut Creek, California, United States, 94598
Overview
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Manager, Provider Contracting - Ancillary/Hospital/Physician Group - Walnut Creek, CA
role at
Living Well Health Center . The job profile for this position is Provider Contracting Advisor, which is a Band 4 Senior Contributor Career Track Role. This role supports the Walnut Creek, CA market; candidate must live in the local area (Walnut Creek, Oakland, Berkeley, San Ramon, Concord, Pleasant Hill, CA areas preferred). Work location: Walnut Creek, CA. Will support the Walnut Creek market; the person will need to live in the local area. Role purpose: The
Manager, Provider Contracting Network Management
serves as an integral member of the Provider Contracting Team and reports to the VP, Network Management. This role assists in developing the strategic direction and management of the day-to-day contracting and network management activities for a local territory. Responsibilities
Manages complex contracting and negotiations for fee-for-service, capitation, and other value-based reimbursements with hospitals and other providers (e.g., hospital systems, ancillaries, and large physician groups). Builds relationships that nurture provider partnerships and seeks broader value-based business opportunities to support the local market strategy. Initiates and maintains effective channels of communication with matrix partners including, but not limited to, Claims Operations, Medical Management, Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing, and Service. Contributes to the development of alternative network initiatives. Supports and provides direction to develop network analytics required for the network solution. Works to meet unit cost targets, while preserving an adequate network, to achieve and maintain Cigna's competitive position. Creates and manages initiatives that improve total medical cost and quality. Drives change with external provider partners by assessing clinical informatics and offering consultative expertise to assist with total medical cost initiatives. Prepares, analyzes, reviews, and projects financial impact of larger or complex provider contracts and alternative contract terms. Creates healthcare provider agreements that meet internal operational standards and external provider expectations. Ensures accurate implementation and administration through matrix partners. Assists in resolving elevated and complex provider service complaints. Researches problems and negotiates with internal/external partners/customers to resolve highly complex and/or escalated issues. Manages key provider relationships and is accountable for critical interface with providers and business staff. Demonstrates knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape. Responsible for accurate and timely contract loading and submissions and interface with matrix partners for network implementation and maintenance. May provide guidance or expertise to less experienced specialists. Qualifications
Should possess a bachelor’s degree; preferably in Finance, Economics, Healthcare or Business related. Significant industry experience will be considered in lieu of a bachelor’s degree. MBA or MHA preferred. 3+ years of Managed Care contracting and negotiating experience involving complex delivery systems and organizations required. Experience in developing and managing key provider relationships. Knowledge of complex reimbursement methodologies, including incentive-based models strongly preferred. Demonstrated experience in seeking out, building and nurturing strong external relationships with provider partners. Intimate understanding and experience with hospital, managed care, and provider business models. Team player with proven ability to develop strong working relationships within a fast-paced, matrix organization. Ability to influence both sales and provider audiences through strong written and verbal communication skills. Experience with formal presentations. Customer-centric and interpersonal skills are required. Demonstrates an ability to maneuver effectively in a changing environment. Superior problem solving, decision-making, negotiating skills, contract language and financial acumen. Knowledge and use of Microsoft Office tools. Additional Information
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10 Mbps download/5 Mbps upload. Compensation: This position anticipates offering an annual salary of 91,200 – 152,000 USD, depending on factors including experience and geographic location. This role is anticipated to be eligible to participate in an annual bonus plan. Benefits: You’ll enjoy a comprehensive range of benefits starting on day one, including medical, vision, dental, well-being and behavioral health programs, 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 details on our employee benefits programs, visit Life at Cigna. Equal Employment Opportunity
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions, 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. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
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Join to apply for the
Manager, Provider Contracting - Ancillary/Hospital/Physician Group - Walnut Creek, CA
role at
Living Well Health Center . The job profile for this position is Provider Contracting Advisor, which is a Band 4 Senior Contributor Career Track Role. This role supports the Walnut Creek, CA market; candidate must live in the local area (Walnut Creek, Oakland, Berkeley, San Ramon, Concord, Pleasant Hill, CA areas preferred). Work location: Walnut Creek, CA. Will support the Walnut Creek market; the person will need to live in the local area. Role purpose: The
Manager, Provider Contracting Network Management
serves as an integral member of the Provider Contracting Team and reports to the VP, Network Management. This role assists in developing the strategic direction and management of the day-to-day contracting and network management activities for a local territory. Responsibilities
Manages complex contracting and negotiations for fee-for-service, capitation, and other value-based reimbursements with hospitals and other providers (e.g., hospital systems, ancillaries, and large physician groups). Builds relationships that nurture provider partnerships and seeks broader value-based business opportunities to support the local market strategy. Initiates and maintains effective channels of communication with matrix partners including, but not limited to, Claims Operations, Medical Management, Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing, and Service. Contributes to the development of alternative network initiatives. Supports and provides direction to develop network analytics required for the network solution. Works to meet unit cost targets, while preserving an adequate network, to achieve and maintain Cigna's competitive position. Creates and manages initiatives that improve total medical cost and quality. Drives change with external provider partners by assessing clinical informatics and offering consultative expertise to assist with total medical cost initiatives. Prepares, analyzes, reviews, and projects financial impact of larger or complex provider contracts and alternative contract terms. Creates healthcare provider agreements that meet internal operational standards and external provider expectations. Ensures accurate implementation and administration through matrix partners. Assists in resolving elevated and complex provider service complaints. Researches problems and negotiates with internal/external partners/customers to resolve highly complex and/or escalated issues. Manages key provider relationships and is accountable for critical interface with providers and business staff. Demonstrates knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape. Responsible for accurate and timely contract loading and submissions and interface with matrix partners for network implementation and maintenance. May provide guidance or expertise to less experienced specialists. Qualifications
Should possess a bachelor’s degree; preferably in Finance, Economics, Healthcare or Business related. Significant industry experience will be considered in lieu of a bachelor’s degree. MBA or MHA preferred. 3+ years of Managed Care contracting and negotiating experience involving complex delivery systems and organizations required. Experience in developing and managing key provider relationships. Knowledge of complex reimbursement methodologies, including incentive-based models strongly preferred. Demonstrated experience in seeking out, building and nurturing strong external relationships with provider partners. Intimate understanding and experience with hospital, managed care, and provider business models. Team player with proven ability to develop strong working relationships within a fast-paced, matrix organization. Ability to influence both sales and provider audiences through strong written and verbal communication skills. Experience with formal presentations. Customer-centric and interpersonal skills are required. Demonstrates an ability to maneuver effectively in a changing environment. Superior problem solving, decision-making, negotiating skills, contract language and financial acumen. Knowledge and use of Microsoft Office tools. Additional Information
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10 Mbps download/5 Mbps upload. Compensation: This position anticipates offering an annual salary of 91,200 – 152,000 USD, depending on factors including experience and geographic location. This role is anticipated to be eligible to participate in an annual bonus plan. Benefits: You’ll enjoy a comprehensive range of benefits starting on day one, including medical, vision, dental, well-being and behavioral health programs, 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 details on our employee benefits programs, visit Life at Cigna. Equal Employment Opportunity
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions, 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. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
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