Hospital / Provider Contracting Network Management Director - Cigna Healthcare - 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.
• 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.
• 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.
• 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.
• Leads in resolving elevated and complex provider service complaints.
• 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 :

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.