Medicare Provider Performance Enablement Lead Analyst - Cigna Healthcare - Hybrid

The Provider Performance External Representative is a key member of the market that assists in the growth and development of the provider network.

The External Representative is the primary conduit to the providers and the individual that represents Cigna MA.

The Provider Performance External Representative's responsibilities include:


* Most likely to have responsibility for non-centralized provider groups requiring 1:1 intervention to improve and/or maintain performance.


* Creates engagement with provider group and leads discussion or organizes PPE partners for effective meetings.


* Develops and executes provider group improvement plans autonomously, with expert-level technical support from manager.


* Knowledge of quality and affordability metrics and tools; effective communication to inform external partners.


* Supporting the development, management and oversight of the physician/ provider network in his/her assigned Mid-Atlantic (MD, DC & VA) region.


* Establishing and managing strong, solid relationships with assigned provider groups and their staff (e.g.

physicians, practice managers, care coordination teams), as well as executing with provider group on initiatives that benefit the customer, provider, and health plan.


* Educating providers on the performance requirements associated with value-based contracts.


* Conducting regular provider visits to educate providers and office staff on topics including, but not limited to: preventative and quality outcome metrics, risk adjustment, medical cost management, etc.


* Schedules, prepares for and participates in meetings with providers, provider staff, and/or physician leadership including creating and delivering presentations.


* Collaborating with Provider Performance Senior Manager/Manager on strategic plans on growth, development, and vision for assigned territory.

Participating with the Senior Manager/Manager in monthly financial review.


* Assisting in initiatives and performing special projects and other duties as assigned by leadership


* Developing time and cost effective territory management in compliance with department and enterprise goals.


* Understanding, developing, tracking, monitoring and reporting on key program performance metrics, such as utilization, coding, and Stars/quality performance.


* Partnering with other internal departments, including but not limited to Health Services, Medical Economics, Sales, and Sales & Risk Adjustment in order to develop solutions for strategic business needs


* May provide guidance to others in the department

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 External Representative is accountable for the growth of the assigned (Mid-Atlantic (MD, DC & VA) region in terms of financial profitability, engageme...