AVP, Provider Network Management - Southern CA market - Cigna Healthcare - Hybrid

LOCATION: HYBRID position aligned to the Southern CA market.

Must reside in Los Angelis/Orange County/Glendale, CA

Will require a weekly schedule of: several days per week working at Home AND several days per week working either in Office or Travel out to in-person meetings with Providers.

The AVP, Network Management serves as an integral member of the Network Management & Affordability Team and reports to the VP, Network Management.

This role is a key contributor to the development of the strategic direction and is accountable for the management of contracting and network management activities for multiple local geographies.

DUTIES AND RESPONSIBILITIES


* Directly manages a contracting team or geography, providing leadership and mentoring to their direct reports.


* Manages increasingly complex contracts and negotiations for fee for service and sophisticated value-based reimbursements with hospitals and other providers for both Cigna's US Commercial and Medicare product lines (e.g., Hospital systems, Ancillaries, and large physician groups) for one or more geographies.


* Proactively builds relationships that nurture provider partnerships and seeks broader value-based business opportunities to support the local market strategy.


* Initiates, nurtures 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.


* Manages strategic positioning for provider contracting, develops networks and identifies and acts upon opportunities for greater value-orientation and risk arrangements.


* Identifying and implementing alternative network initiatives.

Supports and provides direction to develop network analytics required for the network solution.


* Responsible for meeting unit cost targets, while preserving an adequate network, to achieve and maintain Cigna's competitive position.


* Identify 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 high spend or increasingly complex provider contracts and alternate contract terms.


* Creates and / or oversees the development of "HCP" agreements that meet internal operational standards and external provider expectations.

Ensures the 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 comprehensive kn...