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The job profile for this position is Encore, which is a Band 1 Professional Career Track Role.
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ENCORE POSITION
Provider Contracting Director
The role manages a team that executes on sustained growth, revenue and earnings strategy while ensuring compliance with State and Federal regulations. This role has responsibility to grow operational excellence across several teams within the Out of Network Protection Team (ONPT). They include Voluntary Operations, NSA Operations and the Service Team. This role has the responsibility to identifying and implementing new initiatives to control total medical costs.
In addition the role has direct Vendor Management responsibilities across several relationships that directly effects Cigna’s total cost of care. The role has broad matrix management requirements, including Legal, Finance, Claim, Product, Sales, Contracting, and National Appeals.
• Overall Program Savings – Increase annualized savings vs baseline due to national programs, focusing on Out of Network (OON) claims
• Strategic Roadmap – Develop innovative, best-in-class solutions with existing and potential new external vendor partners to address cost issues
• Enterprise Mindset – Drive consistency and value across US Commercial and US Government lines of business
• Vendor Management – Accountability for operational performance of large vendor repricing contracts related of OON Claims management.
• Design and Implementation – Partner with internal business teams to understand requirements, timeframes, and technology considerations and other constraints that must be considered to deliver on new objectives. This includes unique capabilities roadmaps for emerging products (government, individual, alt network)
• Data-Driven Decisions – Continue to develop robust reporting and analytics capabilities in support of changing affordability demands and operational landscape.
• OON Claims Operations – Mature operational approach to managing OON claims across internal and vendor processes to insure consistency and transparency.
• Claims Accuracy – Improve efficiency related to claims flow between Service Operations, NPCC, and Vendors
• Policy – Create policy recommendations and persuade matrix partners to adopt (i.e., service ops, medical policy, contracting and product solutions)
• Best Practices – Optimization of existing practices and development of new ones to quickly address areas of focus, maintaining and extending the business unit’s superior outcomes
• Attract and Develop Talent – Focus on leadership continuity, including support development of current staff while recruitment of additional talent
• Product and Markets – Regular engagement with local markets on performance of national programs and value to Clients
• Matrix Partner Management – Cultivate mutually beneficial relationships of with a network of Matrix Partners that will support Cost Containment goals
QUALIFICATIONS:
• 10+ years industry experience solving business problems through application of innovative analytics, knowledge of healthcare industry dynamics and emerging technologies
• Preferred extensive experience in healthcare industry with out-of-network specific experience a plus
• 10+ years directly supporting claims pricing
• Proven track record for success in building out best-in-class capabilities at the enterprise level identifying, evaluating and deploying successful partnership strategies.
• Experience managing high degree of change and complexity across organization and portfolio
• 10+ years managing external partners and superior knowledge of competitive capabilities
• Advanced degree in business, healthcare or quantitative field with an emphasis on business applications and financial impacts a plus
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.
