Provider Performance Manager- Cigna Healthcare- Houston - Hybrid - The Cigna Group
Houston, TX
About the Job
Role Summary
The Provider Performance 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 directly to the Provider Performance Senior Manager, the Provider Performance 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 (Lead Analysts).
• Leading network performance development within South Texas and 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 (PPMs). Providing guidance to network physicians to focus performance improvement and initiating strategic efforts where necessary.
• Preparing for and facilitating performance reviews 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 facilitating growth, performance and affordability in provider network.
• Developing and executing strategic plans on growth, development, and vision for each South TX provider group, in alignment with broader market and enterprise strategy.
• 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:
a. Growing the MA Business
The Provider Performance Manager is accountable for the growth of the assigned South Texas provider groups in terms of optimal quality performance, financial profitability, and increase in provider network and membership
b. Delivering our Services
The Provider Performance Manager is accountable for the exceptional delivery of services in the assigned South Texas provider groups as evidenced by physician and member satisfaction, improvements on Star Rating and NPS score.
c. Managing our Costs
The Provider Performance Manager ensures the affordability of services in the assigned South Texas provider groups by effective control of various cost levers like Med/OPEX.
d. Developing our People
The Provider Performance Manager provides leadership and management across all the teams in the assigned South Texas provider groups. He/she ensures the effective coaching and management of these teams.
e. 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
- Education: Bachelor’s degree preferred
- Experience: 6-8 years of professional experience + 1-3 years of management experience
- 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
- Location: Houston; South TX
Technology Proficient – Microsoft Outlook, Excel, PowerPoint, and Word
Preferred
• Master’s degree; MBA or other
• Direct experience with health plan operations, preferably specific to government sponsored health plans
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.
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._
The Provider Performance 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 directly to the Provider Performance Senior Manager, the Provider Performance 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 (Lead Analysts).
• Leading network performance development within South Texas and 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 (PPMs). Providing guidance to network physicians to focus performance improvement and initiating strategic efforts where necessary.
• Preparing for and facilitating performance reviews 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 facilitating growth, performance and affordability in provider network.
• Developing and executing strategic plans on growth, development, and vision for each South TX provider group, in alignment with broader market and enterprise strategy.
• 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:
a. Growing the MA Business
The Provider Performance Manager is accountable for the growth of the assigned South Texas provider groups in terms of optimal quality performance, financial profitability, and increase in provider network and membership
b. Delivering our Services
The Provider Performance Manager is accountable for the exceptional delivery of services in the assigned South Texas provider groups as evidenced by physician and member satisfaction, improvements on Star Rating and NPS score.
c. Managing our Costs
The Provider Performance Manager ensures the affordability of services in the assigned South Texas provider groups by effective control of various cost levers like Med/OPEX.
d. Developing our People
The Provider Performance Manager provides leadership and management across all the teams in the assigned South Texas provider groups. He/she ensures the effective coaching and management of these teams.
e. 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
- Education: Bachelor’s degree preferred
- Experience: 6-8 years of professional experience + 1-3 years of management experience
- 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
- Location: Houston; South TX
Technology Proficient – Microsoft Outlook, Excel, PowerPoint, and Word
Preferred
• Master’s degree; MBA or other
• Direct experience with health plan operations, preferably specific to government sponsored health plans
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.
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
