The Cigna Group
Manager, Provider Contracting Network Management - Glendale, CA
The Cigna Group, Glendale, California, us, 91222
Overview
Manager, Provider Contracting Network Management is a role that supports the Glendale, CA market. The position reports to the AVP, Provider Contracting and helps develop the strategic direction and management of day-to-day contracting and network management activities for a local territory. WORK LOCATION
Position supports the Glendale, CA market. Must live in the Glendale/Los Angeles, CA area. 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 Claims Operations, Medical Management, Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing, and Service. Contributes to the development of alternative network initiatives 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 the financial impact of larger or complex provider contracts and alternate 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, including interrelationships and 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. Position Requirements
Bachelor’s degree required; preferably in Finance, Economics, Healthcare or Business. Significant industry experience may be considered in lieu of a degree. MBA or MHA preferred. 3+ years of Managed Care contracting and negotiating experience involving complex delivery systems and organizations. Experience in developing and managing key provider relationships. Knowledge of complex reimbursement methodologies, including incentive-based models, strongly preferred. Demonstrated ability to build and nurture external provider relationships. Understanding of hospital, managed care, and provider business models. Team player with ability to work in a fast-paced, matrix organization. Strong written and verbal communication skills with the ability to influence both sales and provider audiences; experience with formal presentations. Customer-centric interpersonal skills and adaptability in a changing environment. Excellent problem solving, decision-making, negotiating skills, contract language, and financial acumen. Knowledge and use of Microsoft Office tools. If you will be working at home occasionally or permanently, internet connection must be through a cable broadband or fiber optic provider with speeds of at least 10 Mbps download/5 Mbps upload. This position is anticipated to offer an annual salary of 91,200 - 152,000 USD, depending on experience and geographic location, and may be eligible to participate in an annual bonus plan. Benefits
Starting on day one of employment, comprehensive benefits include 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 paid time off per year and paid holidays. For more details, visit Life at Cigna Group. About The Cigna Group
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life, guiding customers through the health care system and providing information to make informed health decisions. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions, including 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. If you require reasonable accommodation in completing the online application process, please email SeeYourself@cigna.com for support. The Cigna Group maintains a tobacco-free policy and reserves the right not to hire tobacco/nicotine users where legally permissible. Some states have restrictions on tobacco use in hiring. Qualified applicants with criminal histories will be considered in accordance with all federal, state and local laws. Seniority level
Mid-Senior level Employment type
Full-time Job function
Information Technology Industries
Hospitals and Health Care
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Manager, Provider Contracting Network Management is a role that supports the Glendale, CA market. The position reports to the AVP, Provider Contracting and helps develop the strategic direction and management of day-to-day contracting and network management activities for a local territory. WORK LOCATION
Position supports the Glendale, CA market. Must live in the Glendale/Los Angeles, CA area. 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 Claims Operations, Medical Management, Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing, and Service. Contributes to the development of alternative network initiatives 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 the financial impact of larger or complex provider contracts and alternate 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, including interrelationships and 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. Position Requirements
Bachelor’s degree required; preferably in Finance, Economics, Healthcare or Business. Significant industry experience may be considered in lieu of a degree. MBA or MHA preferred. 3+ years of Managed Care contracting and negotiating experience involving complex delivery systems and organizations. Experience in developing and managing key provider relationships. Knowledge of complex reimbursement methodologies, including incentive-based models, strongly preferred. Demonstrated ability to build and nurture external provider relationships. Understanding of hospital, managed care, and provider business models. Team player with ability to work in a fast-paced, matrix organization. Strong written and verbal communication skills with the ability to influence both sales and provider audiences; experience with formal presentations. Customer-centric interpersonal skills and adaptability in a changing environment. Excellent problem solving, decision-making, negotiating skills, contract language, and financial acumen. Knowledge and use of Microsoft Office tools. If you will be working at home occasionally or permanently, internet connection must be through a cable broadband or fiber optic provider with speeds of at least 10 Mbps download/5 Mbps upload. This position is anticipated to offer an annual salary of 91,200 - 152,000 USD, depending on experience and geographic location, and may be eligible to participate in an annual bonus plan. Benefits
Starting on day one of employment, comprehensive benefits include 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 paid time off per year and paid holidays. For more details, visit Life at Cigna Group. About The Cigna Group
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life, guiding customers through the health care system and providing information to make informed health decisions. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions, including 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. If you require reasonable accommodation in completing the online application process, please email SeeYourself@cigna.com for support. The Cigna Group maintains a tobacco-free policy and reserves the right not to hire tobacco/nicotine users where legally permissible. Some states have restrictions on tobacco use in hiring. Qualified applicants with criminal histories will be considered in accordance with all federal, state and local laws. Seniority level
Mid-Senior level Employment type
Full-time Job function
Information Technology Industries
Hospitals and Health Care
#J-18808-Ljbffr