AVP, Provider Contract - Western PA and West Virginia markets - Cigna Healthcare - Hybrid

Work Location: Hybrid.

3 days (Tues, Wed, + 1 Flex Day) in Pittsburgh office.

Assistant Vice President, Network Management, Western PA and West Virginia markets

This position serves as an integral member of the Provider Contracting Team and reports to the Vice President, Network Management, Liberty Valley.

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, mentoring, and development opportunities to their direct reports.


* Accountability for managing contracting and network management activity supporting Commercial, Medicare Advantage, and other products/initiatives (i.e.

Exchange products) as applicable to market.


* Manages increasingly complex contracts and negotiations for fee for service and sophisticated value-based reimbursements with hospitals and other providers (e.g., Hospital systems, Ancillaries, and large physician groups) across Western PA and West Virginia.


* Leads cross market and cross functional initiatives as needed.


* 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.


* 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.


* Prepares, analyzes, reviews, and projects financial impact of high spend or increasingly complex provider contracts and alternate contract terms.


* Manages key provider relationships and is accountable for interface with providers and business staff.


* Demonstrates comprehensive 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.

POSITION REQUIREMENTS


* Bachelor's degree strongly preferred; preferably in the areas of Finance, Economics, Healthcare or Business related.

Significant industry experience will be considered in lieu of a Bachelor degree.

MBA or MHA preferred.


* Minimum of 5 years Provider Contracting and Negotiating experience involving complex delivery systems and or...