AVP, Provider Contract Network Management - Atlanta, GA market - Healthcare

AVP, Provider Contract Network Management

The AVP, Provider Contract 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 include :

• 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 IFP product lines.
• 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.
• 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.
• Assists 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 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 implementation and maintenance.
• Partner with Regulatory Affairs to ensure all network filings are timely and accurate.

Position requirements include :

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.

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