Provider Performance Senior Advisor - Georgia - Hybrid - Cigna Healthcare

This role aligns to the Georgia market, incumbent candidate will work from local office 3 days per week.

The Provider Performance Senior Advisor is an integral part of a cross-functional, collaborative organization (which includes Market Provider Performance, Sales, Clinical Operations, Stars & Risk Adjustment, Finance , Cross-Segment Contracting, Provider Relations, and Network Development & Solutions).

Reporting to the Network Operations Senior Manager or Director, this individual ensures the effective performance management of the provider network for his/her assigned sub-market and/or provider groups.

The role of Senior Advisor with the Provider Performance Enablement team takes ownership for performance outcomes of the most complex relationships within the market.

Often this includes multi-site health systems and national primary care clinic partners.

The Provider Performance Senior Advisor's responsibilities include:


* Developing and managing the local physician/provider network, engaging with providers and internal stakeholders to drive high performance in quality and cost efficiency, designing and implementing programs to maintain positive relationships between the health plan, physician, providers, and practice managers.


* Responsible for oversight of provider group financials, including monthly action plans, reviews, and verification as it relates to value based incentive contracts and performance.


* Providing feedback and recommendations regarding participation or non-participation with new or existing agreements and financial and/or operational issues with providers.


* Leading Stars & Risk Adjustment outcomes through local Provider Performance initiatives.

Developing and implementing programs to achieve enhanced quality and affordability through physician education, training and provision of reporting and using analytics resources to identify key opportunities for utilization and cost management.


* Acting as government program knowledge leader for the local market.


* Responsible for maintaining compliance to CMS and company policies and guidelines.


* Leading market initiatives and performing special projects and other duties as assigned by leadership.

Role Components

All market team members contribute to the growth and profitability of the Medicare Advantage business in their market in the following aspects:

Growing the MA Business :

The Provider Performance Senior Advisor is accountable for the growth of the assigned market in terms of financial profitability, and Star rating performance.

Delivering our Services :

The Provider Performance Senior Advisor is accountable for the exceptional delivery of services in the assigned market as evidenced by physician and member satisfaction, improvements on Star Rating and NPS score.

Managing our Costs :

The Provider Performance Senior Advisor ensures the affordability of services in the assigned market by effective control of various cost levers....