Medicare Provider Performance Enablement Operations Manager - Cigna Healthcare - Hybrid

Role Summary

The Medicare Provider Performance Enablement Manager is a key member of a cross-functional, collaborative organization (which includes Market Provider Performance, Sales, Health Services, Clinical, Stars & Risk Adjustment, Finance, Marketing, Cross-Segment Contracting, Provider Relations, and Network Development & Solutions).

Reporting to the Provider Performance Senior Manager / Operations Director / Operations Senior Director (Market President), the Provider Performance Enablement Manager ensures the effective management of the performance outcomes of the provider network.

The Provider Performance Manager’s responsibilities include :

• Developing and managing talent of direct reports (Senior Analyst / Lead Analyst) in Provider Performance Enablement.
• Leading network development within Huntsville, Montgomery, and Birmingham hubs, as well as surrounding areas
• cultivating key provider partner relationships in order to drive optimal performance on Stars, risk adjustment, utilization management, and overall financial performance.
• Leading market level projects and strategies related to provider engagement.
• Preparing for and facilitating external physician meetings and value based contract administrative meetings (JOCs).
• Preparing for and facilitating a monthly financial review to senior management, including but not limited to financials, quality and coding progress, action plans, reviews / evaluations and any accompanying analysis.
• Driving excellence in compliance, consistency in approach to being the partner of choice for providers, and approach to driving growth, performance and affordability in provider network.
• Developing and executing strategic plans on growth, development, and vision withing local markets, bringing it together for entire market.
• Responsible for maintaining compliance to CMS and company policies and guidelines.
• Leading cross-market, cross-functional initiatives and performing special projects and other duties as assigned by leadership.

Role Components

• All market team members contribute to the growth and profitability of the Medicare Advantage business in their market in the following aspects :
• Growing the MA Business : The Provider Performance Manager is accountable for the growth in Alabama in terms of financial profitability, increase in provider network and membership
• Delivering our Services : The Provider Performance Manager is accountable for the exceptional delivery of services in local markets as evidenced by physician and member satisfaction, improvements on Star Rating and NPS score.
• Managing our Costs : The Provider Performance Manager ensures the affordability of services by effective control of various cost levers like Med / OPEX.
• Developing our People : The Provider Performance Manager provides leadership and management across all the teams. He / she ensures the effective coaching and management of these teams.
• Collaborating with our Partners : The Provider Performance Manager seamlessly collaborates with all applicable partners to solve for Cigna’, and may lead cross-functional or cross-market initiatives that improve service delivery within the business.

Qualifications and Competencies

• Location : Must be located in the Birmingham, AL or surrounding counties
• Bachelor’s degree or equivalent work experience
• 5+ years of direct provider-facing experience or direct health plan experience with STARS, HEDIS, Risk Adjustment and medical expense reduction, specific to Medicare Advantage preferred
• Ability and track record of thinking strategically, applying an enterprise mindset and business acumen resulting in meeting or exceeding goals in growth and profitability
• Keen customer focus and ability to develop strong, lasting relationships with providers resulting in deeper collaboration and satisfaction
• Capacity for leading initiatives and influencing people on cross-functional teams; ability to drive transparency and accountability, and learn the strengths and weaknesses of the team so as to inform leadership to put people in a position to succeed
• Ability to develop strong relationships across multiple levels of the organization
• Effective communicator
• Technology Proficient Microsoft Outlook, Excel, PowerPoint, Excel, and Word
20 days ago