AVP, Provider Contracting Network Management - Glendale, CA market
LOCATION: HYBRID position aligned to the Glendale, CA market.
Must reside in Los Angeles/Orange County/Glendale, CA
Will require a weekly schedule of several days per week working in Office or Travel out to in-person meetings with Providers AND several days working from Home
The AVP, Provider Contracting 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.
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 comprehensiv...
- Rate: Not Specified
- Location: Glendale, US-CA
- Type: Permanent
- Industry: Finance
- Recruiter: Cigna
- Contact: Recruiter Name
- Email: to view click here
- Reference: 24009041
- Posted: 2024-09-18 08:51:06 -
- View all Jobs from Cigna
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