Job Description
What You'll Do The Medicare National Contracting Advisor position is an integral member of the National Development and Network Solutions team, reporting directly to the Medicare National Partnerships Director. This role is a key contributor for the development of a national provider and vendor value-based network and is accountable for the management of complex contracting and network management activities for the rapidly expanding Cigna Medicare business. You must possess the energy to mobilize a matrixed team responsible for contracting national value-based providers and engaging in parallel affordability initiatives at all stages of the value-based continuum.
Core Responsibilities: - Leads and manages value-based negotiations for national contracts of all provider types. Manage ongoing contractual relationships with emphasis on shared growth, meeting both internal contract standards and provider expectations of service excellence. Tracks and monitors financial performance of contracts.
- Evaluate opportunities and strategic positioning to establish new national risk and value-based provider partnerships that contribute meaningfully to financial, affordability, growth and quality performance targets for Cigna Medicare. Negotiate and contract provider service and vendor agreements and ensure accurate implementation and downstream administration of value-based and risk contracts through matrix partners.
- Ensures compliance with contracting and compliance guidelines.
- Provide counsel and advice as a top Subject Matter Expert to management and Medicare Advantage stakeholders for complex value-based and downside risk reimbursement methodologies for Medicare provider contracting matters.
- Initiates and maintains effective channels of communication with matrix partners to vet contract impact, including but not limited to: Claims, Medical Management, Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing, Grievance, Appeals, and Customer Service that may have downstream impacts relative to provider contracts.
- Individual contributor, highly-matrixed role. Must work by influence/building relationships with others and ensuring effective and positive relationship across Cigna organization.
- Leads the planning and implementation of enterprise-wide initiatives related to provider contracting strategy, affordability, and network design and regularly interfaces with senior management.
What You Bring: - Minimum of five years' experience directly negotiating complex provider agreements; Medicare experience strongly preferred.
- Degree in health administration, business administration, public health, policy, law, or related field (Master's Degree desirable) or compared work experience
- Working knowledge of provider contracting competitor strategies, complex contracting methodologies, value-based payments, and regulatory requirements.
- Knowledge of value-based reimbursement structures and payment methodologies for both hospitals and providers is required.
- Experience in developing and managing relationships across a cross-functional and matrixed environment
- Effective communicator to executives and external audiences, balanced with strong interpersonal skills.
- A team player with experience in complex environments with the ability to build consensus among divergent interests and competing organizational needs
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
About Cigna Healthcare Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Job Tags
Permanent employment, Contract work, Work experience placement, Work from home,