Hospital/Provider Contracting Network Management Director - Cigna Healthcare - Scottsdale, AZ

WORK LOCATION: Scottsdale, AZ

Director Hospital / Provider Network Management Contracting serves as an integral member of the Provider Contracting Team and reports to the AVP, 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 geographies within Arizona.

DUTIES AND RESPONSIBILITIES:


* Manages complex contracting and negotiations for fee for service and value-based reimbursements with hospitals and other providers (e.g., Hospital systems, Ancillaries, and large physician groups).


* Point person for complex projects related to contracting strategy in the market.


* Builds relationships that nurture provider partnerships and seeks broader value-based business opportunities to support the local market strategy.


* Initiates 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 opportunities for greater value-orientation and risk arrangements.


* Contributes to the development of alternative network initiatives.

Supports and provides direction to develop network analytics required for the network solution.


* Works to meet unit cost targets, while preserving an adequate network, to achieve and maintain Cigna's competitive position.


* Creates 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 larger or complex provider contracts and alternate contract terms.


* Creates "HCP" agreements that meet internal operational standards and external provider expectations.

Ensures the accurate implementation, and administration through matrix partners.


* Leads in resolving elevated and complex provider service complaints.

Researches 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 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:


* Should possess a bachelor degree; preferably in the areas of Finance, Economics, Healthcare or Business related.

Significant industry experience will be considered ...