National Provider Network Access Senior Manager - Healthcare - The Cigna Group
Bloomfield, CT
About the Job
WORK LOCATION: REMOTE position
POSITION SUMMARY
This high impact Contracting resource has as its main focus increasing the Affordability and competitiveness of Cigna's delivery system with new and existing products. The position partners closely with Regional and National Leaders in Contracting, Provider Services, Product, Legal, Network Operations, Compliance and Sales Segments to monitor Cigna's provider networks access and availability for Cigna's customers thereby, enhancing our competitive positioning and opportunities for membership growth.
This position has national lead dotted line responsibility for Market Network Advisors, in establishing standard job descriptions, training and in working with matrix partners. This role will also be responsible for leading medical network adequacy monitoring activities, driving targeted network recruitment efforts, vendor management, network performance guarantee business owner.,
The position will also own termination management and the management of all standard operating procedures related to termination management and the other functions mentioned above. This individual will manage a national team and assist other personnel in the department related to Product, Unit Cost, Reporting and Competitive Insights. The position will work closely with Regional Network Access Leads to drive consistency across regions and to share best practices. This position is responsible for working in a highly matrixed organization in a collaborative manner and exhibiting behaviors, attitudes and actions that demonstrate a high level of teamwork.
DUTIES AND RESPONSIBILITIES
+ Champion needed changes nationally with matrix partners to drive changes that will enhance Cigna's competitive access position
+ Business owner for national vendor agreements reviewing and reporting on network access and adequacy including Quest and Zelis Analytics.
+ Business Owner of Sales performance guarantees related to network.
+ Manage the Provider Recruitment process on a national basis driving new sources for provider non-par or adequacy gap closures and coordination with Regional Access Leads and Markets.
+ Lead efforts to proactively communicate network adequacy monitoring results to matrix partners
+ Partner closely with Sales segments to support termination management, competitive network requests, performance guarantees, and recruitment enhancement or other needs.
+ Drive the creation of actionable information from multiple data sources to support internal and external customers
+ Effectively manage team of resources to assist in Network Development, Network Adequacy, Termination Management and Reporting activity
+ Coordinate activities with personnel who are also involved in delivering critical Network and provider information.
+ Manages the process to review, interpret, communicate, and collect key information to and from Contracting, Sales, HealthCare Professional Solutions, Corporate work teams and other matrix partners.
+ Coordinates and participates in all relevant Access Initiative steering or work team meetings as deemed appropriate.
+ Leads the development of annual targeted Network Development plans in coordination with Regional Access Leads. Works closely with the Medical Recruitment Team (MRT) to plan for needed resources to support efforts.
+ Leads the national termination management of the pending termination process. Drive needed enhancements within the department and with matrix partners.
+ Identify and escalate risks and formulate recommended solutions nationally. Must have the ability to drive change in a large, heavily matrixed organization.
+ Business Owner of network access policies for the department
+ National lead of alternative network implementations and adequacy monitoring for the Market Network Advisor role driving consistency across markets. Owns the creation and maintenance of Market Network Advisor job descriptions, training and representation with matrix partners.
+ Special projects as required
POSITION REQUIREMENTS
+ Bachelor’s Degree and MBA or Master’s Degree in HealthCare Administration or health-related field preferred
+ 7+ years Managed Healthcare experience
+ 5+ years’ experience within Provider Contracting, Product, Compliance or Provider Network Management, including management of any monitoring activities to ensure provider networks are adequate, required
+ 4+ years management experience, required
+ Strong database management and analysis background with 3-5 years experience in diverse settings, preferably managed care.
+ Technical/Functional expertise: Contracting, Negotiating, Provider Services, Financial Analysis, Project Management
+ Ability to analyze and interpret both qualitative and quantitative provider data and summarize in an effective and user friendly format. Demonstrated ability to translate data and matrix impact between different functional areas.
+ Excellent interpersonal and customer service skills, with demonstrated ability to influence internal and external resources.
+ Excellent written and oral communication skills and experience working in an empowered team environment;
+ Works productively in an environment that requires constant development of technical data skill sets.
+ Highly skilled on Excel, Access, PowerPoint and other relevant software applications .
+ Self starter with excellent analytical, technical, and project management skills in a matrix organization
+ Ability to understand the business objectives and technology as well as underlying data required to support product needs.
+ Demonstrated ability to work at both conceptual and very detailed levels and easily shifts between the two.
+ Identifies ways to efficiently improve the collection of data, reduce operational costs, always focusing on results.
+ In-depth understanding of managed care business processes, products, data, systems, and providers
+ Takes quick, decisive, informed action on issues or problems judged as critical.
+ Demonstrates knowledge of HealthCare Professionals data and structure. Understands interrelationships among HealthCare Professionals in regional markets.
+ Be a resource for Sales as a network subject matter expert, assisting in escalated disruption reviews and in responding to questions on Network access.
+ Some travel required
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.
For this position, we anticipate offering an annual salary of 127,900 - 213,100 USD / yearly, depending on relevant factors, including experience and geographic location.
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 .
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.
_Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws._
_If you require reasonable accommodation in completing the online application process, please email:_ _SeeYourself@cigna.com_ _for support. Do not email_ _SeeYourself@cigna.com_ _for an update on your application or to provide your resume as you will not receive a response._
_The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State._
_Qualified applicants with criminal histories will be considered for employment in a manner_ _consistent with all federal, state and local ordinances._
POSITION SUMMARY
This high impact Contracting resource has as its main focus increasing the Affordability and competitiveness of Cigna's delivery system with new and existing products. The position partners closely with Regional and National Leaders in Contracting, Provider Services, Product, Legal, Network Operations, Compliance and Sales Segments to monitor Cigna's provider networks access and availability for Cigna's customers thereby, enhancing our competitive positioning and opportunities for membership growth.
This position has national lead dotted line responsibility for Market Network Advisors, in establishing standard job descriptions, training and in working with matrix partners. This role will also be responsible for leading medical network adequacy monitoring activities, driving targeted network recruitment efforts, vendor management, network performance guarantee business owner.,
The position will also own termination management and the management of all standard operating procedures related to termination management and the other functions mentioned above. This individual will manage a national team and assist other personnel in the department related to Product, Unit Cost, Reporting and Competitive Insights. The position will work closely with Regional Network Access Leads to drive consistency across regions and to share best practices. This position is responsible for working in a highly matrixed organization in a collaborative manner and exhibiting behaviors, attitudes and actions that demonstrate a high level of teamwork.
DUTIES AND RESPONSIBILITIES
+ Champion needed changes nationally with matrix partners to drive changes that will enhance Cigna's competitive access position
+ Business owner for national vendor agreements reviewing and reporting on network access and adequacy including Quest and Zelis Analytics.
+ Business Owner of Sales performance guarantees related to network.
+ Manage the Provider Recruitment process on a national basis driving new sources for provider non-par or adequacy gap closures and coordination with Regional Access Leads and Markets.
+ Lead efforts to proactively communicate network adequacy monitoring results to matrix partners
+ Partner closely with Sales segments to support termination management, competitive network requests, performance guarantees, and recruitment enhancement or other needs.
+ Drive the creation of actionable information from multiple data sources to support internal and external customers
+ Effectively manage team of resources to assist in Network Development, Network Adequacy, Termination Management and Reporting activity
+ Coordinate activities with personnel who are also involved in delivering critical Network and provider information.
+ Manages the process to review, interpret, communicate, and collect key information to and from Contracting, Sales, HealthCare Professional Solutions, Corporate work teams and other matrix partners.
+ Coordinates and participates in all relevant Access Initiative steering or work team meetings as deemed appropriate.
+ Leads the development of annual targeted Network Development plans in coordination with Regional Access Leads. Works closely with the Medical Recruitment Team (MRT) to plan for needed resources to support efforts.
+ Leads the national termination management of the pending termination process. Drive needed enhancements within the department and with matrix partners.
+ Identify and escalate risks and formulate recommended solutions nationally. Must have the ability to drive change in a large, heavily matrixed organization.
+ Business Owner of network access policies for the department
+ National lead of alternative network implementations and adequacy monitoring for the Market Network Advisor role driving consistency across markets. Owns the creation and maintenance of Market Network Advisor job descriptions, training and representation with matrix partners.
+ Special projects as required
POSITION REQUIREMENTS
+ Bachelor’s Degree and MBA or Master’s Degree in HealthCare Administration or health-related field preferred
+ 7+ years Managed Healthcare experience
+ 5+ years’ experience within Provider Contracting, Product, Compliance or Provider Network Management, including management of any monitoring activities to ensure provider networks are adequate, required
+ 4+ years management experience, required
+ Strong database management and analysis background with 3-5 years experience in diverse settings, preferably managed care.
+ Technical/Functional expertise: Contracting, Negotiating, Provider Services, Financial Analysis, Project Management
+ Ability to analyze and interpret both qualitative and quantitative provider data and summarize in an effective and user friendly format. Demonstrated ability to translate data and matrix impact between different functional areas.
+ Excellent interpersonal and customer service skills, with demonstrated ability to influence internal and external resources.
+ Excellent written and oral communication skills and experience working in an empowered team environment;
+ Works productively in an environment that requires constant development of technical data skill sets.
+ Highly skilled on Excel, Access, PowerPoint and other relevant software applications .
+ Self starter with excellent analytical, technical, and project management skills in a matrix organization
+ Ability to understand the business objectives and technology as well as underlying data required to support product needs.
+ Demonstrated ability to work at both conceptual and very detailed levels and easily shifts between the two.
+ Identifies ways to efficiently improve the collection of data, reduce operational costs, always focusing on results.
+ In-depth understanding of managed care business processes, products, data, systems, and providers
+ Takes quick, decisive, informed action on issues or problems judged as critical.
+ Demonstrates knowledge of HealthCare Professionals data and structure. Understands interrelationships among HealthCare Professionals in regional markets.
+ Be a resource for Sales as a network subject matter expert, assisting in escalated disruption reviews and in responding to questions on Network access.
+ Some travel required
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.
For this position, we anticipate offering an annual salary of 127,900 - 213,100 USD / yearly, depending on relevant factors, including experience and geographic location.
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 .
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.
_Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws._
_If you require reasonable accommodation in completing the online application process, please email:_ _SeeYourself@cigna.com_ _for support. Do not email_ _SeeYourself@cigna.com_ _for an update on your application or to provide your resume as you will not receive a response._
_The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State._
_Qualified applicants with criminal histories will be considered for employment in a manner_ _consistent with all federal, state and local ordinances._
Source : The Cigna Group
