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The job profile for this position is Network Operations Lead Analyst, which is a Band 3 Senior Contributor Career Track Role.
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The Provider Performance External Representative is a key member of the market that assists in the growth and development of the provider network. The External Representative is the primary conduit to the providers and the individual that represents Cigna MA.
The Provider Performance External Representative’s responsibilities include:
• Most likely to have responsibility for non-centralized provider groups requiring 1:1 intervention to improve and/or maintain performance.
• Creates engagement with provider group and leads discussion or organizes PPE partners for effective meetings.
• Develops and executes provider group improvement plans autonomously, with expert-level technical support from manager.
• Knowledge of quality and affordability metrics and tools; effective communication to inform external partners.
• Supporting the development, management and oversight of the physician/ provider network in his/her assigned Mid-Atlantic (MD, DC & VA) region.
• Establishing and managing strong, solid relationships with assigned provider groups and their staff (e.g. physicians, practice managers, care coordination teams), as well as executing with provider group on initiatives that benefit the customer, provider, and health plan.
• Educating providers on the performance requirements associated with value-based contracts.
• Conducting regular provider visits to educate providers and office staff on topics including, but not limited to: preventative and quality outcome metrics, risk adjustment, medical cost management, etc.
• Schedules, prepares for and participates in meetings with providers, provider staff, and/or physician leadership including creating and delivering presentations.
• Collaborating with Provider Performance Senior Manager/Manager on strategic plans on growth, development, and vision for assigned territory. Participating with the Senior Manager/Manager in monthly financial review.
• Assisting in initiatives and performing special projects and other duties as assigned by leadership
• Developing time and cost effective territory management in compliance with department and enterprise goals.
• Understanding, developing, tracking, monitoring and reporting on key program performance metrics, such as utilization, coding, and Stars/quality performance.
• Partnering with other internal departments, including but not limited to Health Services, Medical Economics, Sales, and Sales & Risk Adjustment in order to develop solutions for strategic business needs
• May provide guidance to others in the department
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 External Representative is accountable for the growth of the assigned (Mid-Atlantic (MD, DC & VA) region in terms of financial profitability, engagement of provider network and membership growth.
• Delivering our Services: The Provider Performance External Representative is accountable for the exceptional delivery of services in the assigned (Mid-Atlantic (MD, DC & VA) region as evidenced by physician and member satisfaction, improvements on Stars and NPS score.
• Managing our Costs: The Provider Performance External Representative assists in ensuring the affordability of services in the assigned Mid-Atlantic (MD, DC & VA) region by applying his/her influence, where applicable, to various cost levers within his/her control.
• Developing our People: The Provider Performance External Representative provides leadership and management across team/s in the assigned Mid-Atlantic (MD, DC & VA) region if applicable, or informally mentors team members as appropriate.
• Collaborating with our Partners: The Provider Performance External Representatives seamlessly collaborates with all applicable partners to ‘solve for Cigna’, and may lead initiatives within his/her that improve service delivery within the business or assist in other special projects.
Qualifications and Competencies
• Bachelor’s degree or equivalent direct experience with health plan operations, preferably specific to government sponsored health plans.
• 3+ years of direct provider-facing experience or direct health plan experience with STARS, HEDIS, Risk Adjustment and medical expense reduction, specific to Medicare Advantage required
• Required – Microsoft Outlook, Excel, PowerPoint, Excel, and Word
• Tableau experience preferred
• Ability to apply an enterprise mindset with business acumen resulting in meeting goals in growth and profitability
• Shows ability to think strategically, 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 teams;
• Ability to develop strong relationships across multiple levels of the organization
• Effective communicator
• Location: Mid-Atlantic (MD, DC & VA). Required to be in office or provider facing 3 days per week.
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.
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.
Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.
