AVP, Provider Contracting Network Management - Glendale, CA market
LOCATION: HYBRID position aligned to the Glendale, CA market. Must reside in Los Angeles/Orange County/Glendale, CA.
Will require a weekly schedule of several days per week working in Office or Travel out to in-person meetings with Providers AND several days working from Home.
The AVP, Provider Contracting 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
- 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 Medicare product lines (e.g., Hospital systems, Ancillaries, and large physician groups) for one or more geographies.
- 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 including but not limited to, Claims Operations, Medical Management, Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing and Service.
- 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. Ensures the accurate implementation and administration through matrix partners.
- Assists in resolving elevated and complex provider service complaints. Research 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
- Should possess a Bachelor’s degree; preferably in the areas of Finance, Economics, Healthcare or Business related. MBA or MHA preferred.
- 5+ years Contracting and Negotiating experience involving complex delivery systems and organizations required.
- Experience with Physician, Hospital and Ancillary group contracting and negotiations.
- Experience negotiating delegated, capitated agreements in California.
- Knowledge of HMO pay-for-performance and IHA’s role in the industry.
- Experience with Healthcare – Commercial.
- Prior experience managing direct reports and leading project teams in a non-centralized work environment.
- Experience in developing and managing key provider relationships including senior executives.
- Knowledge of complex reimbursement methodologies, including incentive-based models required.
- Demonstrated experience in seeking out, building and nurturing strong external relationships with provider partners.
- Intimate understanding and experience with larger, more complex integrated delivery systems, 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 managerial courage and change leadership in a dynamic environment.
- Superior problem solving, decision-making, negotiating skills, contract language and financial acumen.
- Proficient with Microsoft Office (Word, Excel, PowerPoint, Outlook).
- Proficient in contract building software such as Contract Manager.
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