Regional Medicare Provider Contracting Senior Manager - Cigna Healthcare - Pacific Northwest and Mou

The Regional Medicare Provider Contracting Senior Manager serves as an integral member of the Network Development and Solutions Team for the Pacific Northwest and Mountain StatesRegion and reports to the Medicare Provider Contracting Regional Vice President.

This role is a key contributor to the development of the strategic direction of assigned markets and is accountable for the management of value-based and fee-for-service contracting and network management activities for multiple local geographies.

DUTIES AND RESPONSIBILITIES


* Directly manages a contracting team and 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 Cigna's 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, local market provider engagement, claims operations, clinical, Legal, analytics, compliance, sales, and provider relations.


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


* 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 and marketable 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.


* Creates and/or oversees the development of Provider agreements (ie: Hospital systems, ancillaries, and physician groups) 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.

Research 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 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 implementati...