Manager, Provider Contracting - Ancillary / Hospital / Physician Group - Walnut Creek, CA

Manager, Provider Contracting Network Management

The Manager, Provider Contracting Network Management serves as an integral member of the Provider Contracting Team and reports to the VP, Network Management. This role assists in developing the strategic direction and management of the day to day contracting and network management activities for a local given territory.

Duties And Responsibilities

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

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.

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 healthcare provider 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. 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.

May provide guidance or expertise to less experienced specialists.

Position Requirements

Should possess a bachelor's degree; preferably in the areas of Finance, Economics, Healthcare or Business related. Significant industry experience will be considered in lieu of a bachelor's degree. MBA or MHA preferred.

3+ years Managed Care contracting and negotiating experience involving complex delivery systems and organizations required.

Experience in developing and managing key provider relationships

Knowledge of complex reimbursement methodologies, including incentive based models strongly preferred.

Demonstrated experience in seeking out, building and nurturing strong external relationships with provider partners.

Intimate understanding and experience with hospital, managed care, and provider business models.

Team player with proven ability to develop strong working relationships within a fast-paced, matrix organization.

The ability to influence both sales and provider audiences through strong written and verbal communication skills. Experience with formal presentations.

Customer centric and interpersonal skills are required.

Demonstrates an ability to maneuver effectively in a changing environment.

Superior problem solving, decision-making, negotiating skills, contract language and financial acumen.

Knowledge and use of Microsoft Office tools.

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.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group.

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.