Job details
Job type full-time
Full job description
Job summary:
This role will be responsible for executing the individual and family plans (ifp) network and contracting strategies that drive growth, affordability, competitive position, population health management efforts and financial performance in the risk adjustment areaThe key role will serve as a strategic leader within the ifp teamThis role will have a major impact on financial performance due to its focus on optimizing local network constructs and providing contracting strategy guidance, with a particular focus on value-based models and identifying ifp-specific alliances that may vary from cigna`s commercial employer constructKey to this role will be understanding the interplay of networks and contracting methodologies with our provider incentive goals, population health management objectives and our focus on risk adjustment optimizationUnderstanding the dynamics of the aca market, particularly market rates and negotiating position, will be a crucial aspect of this roleThis role will work across the organization and partner with enterprise teams and local market contractors to lead the ifp agenda and deliver outcomes in partnership with those teams.
Core responsibilities:
Lead, execute and optimize provider network constructs in existing and expansion markets for ifp.
Set the strategic direction for identifying and contracting a provider network that drives improved quality and utilization management with a focus on population health management.
Analyze existing network constructs to identify affordability opportunities and care gaps; guide contracting and recruiting efforts of primary, secondary and ancillary providers that orient around population health management and the exchange population.
Identify non-traditional primary, secondary and ancillary providers that should be brought into the ifp/medicaid network to better manage the ifp population costs and outcomes (e.gFederally qualified health centers that have a population health orientation).
Lead strategy for ifp fee-for-service contracting through the creation of segment contracting standards, rate agreements and unique payment methodologies.
Own the segment value-based strategy that will drive improved cost and quality outcomes by developing sophisticated value-based reimbursement programs, guiding contract design and leading the program management, including use of competitive intelligence that drives improved outcomes in negotiations.
Develop and be accountable for execution of overall strategy for provider contracting, network development and identification of opportunities for greater value-based and risk arrangements.
Identify and solve for gaps in cigna’s current contracting process using prior ifp/medicaid contracting and local market experience.
Work with ifp segment resources and enterprise partners to create health care professional agreements, templates and contract standards that meet internal operational standards and external provider expectations.
Influence negotiations for fee-for-service and sophisticated value-based reimbursements with hospitals and other providers (e.g., hospital systems, ancillaries, and large physician groups) that are tied to multiple cigna lines of business.
Identify and escalate significant network and contracting issues to ifp leadership colleagues, develop solutions, and communicate solutions to segment and local market leaders.
Lead and manage team of network advisors aligned to existing and expansion states.
Collaborate with segment, enterprise and local market matrix partners and stakeholders on segment initiatives by exercising strength in organizational agility.
Minimum qualifications:
Minimum of 10 years contracting and negotiating experience involving complex delivery systems and organizations for ifp and/or medicaid business required.
Bachelor`s degree strongly preferred; preferably in the areas of finance, economics, healthcare or business relatedSignificant industry experience will be considered in lieu of a bachelor degreeMba or mha preferred.
Experience building new networks across multiple markets required.
Experience in developing and managing key provider relationships including senior executives in the local market.
Knowledge of complex reimbursement methodologies, including incentive based models required.
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 skillsExperience with formal presentations.
Superior problem solving, decision-making, negotiating skills, contract language and financial acumen.
Knowledge and use of microsoft office tools.
This role is wah/flex which allows most work to be performed at homeEmployees must be fully vaccinated if they choose to come onsite.
This position is not eligible to be performed in colorado.
About cigna
Cigna corporation exists to improve livesWe are a global health service company dedicated to improving the health, well-being and peace of mind of those we serveTogether, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millionsThrough our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovationWhen you work with us, or one of our subsidiaries, you’ll enjoy meaningful career experiences that enrich people’s livesWhat difference will you make?
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 supportDo not email seeyourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.
