Provider Contracting Director - Cigna Healthcare - Florida Market

Role Summary

Reporting to the Florida Market Network Leader, this position has overall accountability for managing the hospital and physician provider contracting functions for assigned geographies within the Florida markets. This role has accountability for executing the Regional/National Network Contracting & Affordability strategy within the market, and also partners closely with leadership from key matrix partners to develop and implement the market strategy to support medical cost improvement and profitable growth in the assignment market. 

This role is responsible for managing total medical cost for their assigned territory, including the execution of a total unit cost plan, provider collaborative and value-based initiatives, and network access and provider satisfaction/network stability across all Cigna products.

Duties & Responsibilities

• Within the markets, leads the technical operations of the Contracting functions, including service area analysis, physician contracting, network development, and problem resolution.

• Contributes to and executes the markets strategic planning, direction and evaluation of the Contracting departments.

• Partners closely with leadership from our key matrix partners from Sales, Underwriting, Medical Economics, etc. in developing and implementing a market strategy to support medical cost improvement and profitable growth in this market.

• Leads and participates in market-based vendor negotiations. Interfaces with senior leaders in the medical community. Negotiates, evaluates and writes physician contracts in order to partner with quality, cost-effective providers of healthcare services within the defined geographic area and drives competitive unit cost relative to top tier competitors across all Cigna products. Conducts market-based financial analysis and participates in cross-functional teams to analyze business opportunities and address critical issues (e.g. network growth, provider termination, etc.)

• Supports growth and persistency through strategic collaboration with Market Medical Execs, Sales and Account Management to achieve Regional/Market Segment Sales goals

• Executes/ensures compliance with Cigna Healthcare National Contracting standards

• Drives improvement in market Provider and Member satisfaction results by partnering with Medical Management, Marketing, Finance, and Service Organization staff

• Identifies opportunities for service improvements and cost savings. Manages the execution of market-based total medical cost plans and manages medical expenses across all Cigna products

• Participates in the development of financial plans, business plans and strategy to support administrative, financial, and marketing objectives

• Manages the markets provider relationships and identifies opportunities for improvement in provider education and communication

• Ensures that provider data is loaded timely and accurately in support of administrative and accuracy objectives

• Responsible for People Strategy within their department, including successful execution of all attraction, development, motivation and retention efforts

• Coordinates all budget and expense management activities through effective planning, monitoring and forecasting

Qualifications:

• Bachelor’s Degree; MBA or Master’s Degree in HealthCare Administration or health-related field preferred

• Minimum of 10 years managed healthcare experience

• Extensive experience (10 years, preferred) in provider contracting and network development involving complex hospital systems, integrated delivery systems and large physician groups (IPAs and PPMs) etc., including risk arrangements

• Excellent knowledge of hospital and managed care finance

• Strong knowledge of managed care (e.g. network design, products, customer service, provider communities, etc.) regulatory environment and compliance issues (e.g. NCQA accreditation issues, credentialing, delegation and oversight standards, etc.)

• Excellent interpersonal and relationship management skills

• Excellent oral, written and presentation skills

• Proven ability to function in a heavily matrixed environment

• Proven ability to foster collaboration, value others perspective and gain support and buy-in for organization proposals

• Proven success in managing growth and charge of business operations. Proven ability to drive and lead an organization through significant change

• Strong organizational and analytical skills that result in conclusive recommendations

• Ability to drive results, think strategically and implement a national strategy

• Ability to establish community-based partnerships with providers and other stakeholders

• Proficient with Excel, Word and presentation applications

• Technical/Functional expertise: Contracting, Negotiating, Provider Services, Financial Management, Project Management

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 need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance.  Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

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.