National Provider Network Access Senior Manager - Healthcare

WORK LOCATION: REMOTE position

POSITION SUMMARY

This high impact Contracting resource has as its main focus increasing the Affordability and competitiveness of Cigna's delivery system with new and existing products.  The position partners closely with Regional and National Leaders in Contracting, Provider Services, Product, Legal, Network Operations, Compliance and Sales Segments to monitor Cigna's provider networks access and availability for Cigna's customers thereby, enhancing our competitive positioning and opportunities for membership growth. 

This position has national lead dotted line responsibility for Market Network Advisors, in establishing standard job descriptions, training and in working with matrix partners.  This role will also be responsible for leading medical network adequacy monitoring activities, driving targeted network recruitment efforts, vendor management, network performance guarantee business owner.,

The position will also own termination management and the management of all standard operating procedures related to termination management and the other functions mentioned above.  This individual will manage a national team and assist other personnel in the department related to Product, Unit Cost, Reporting and Competitive Insights.  The position will work closely with Regional Network Access Leads to drive consistency across regions and to share best practices.  This position is responsible for working in a highly matrixed organization in a collaborative manner and exhibiting behaviors, attitudes and actions that demonstrate a high level of teamwork. 

DUTIES AND RESPONSIBILITIES

• Champion needed changes nationally with matrix partners to drive changes that will enhance Cigna's competitive access position

• Business owner for national vendor agreements reviewing and reporting on network access and adequacy including Quest and Zelis Analytics. 

• Business Owner of Sales performance guarantees related to network.

• Manage the Provider Recruitment process on a national basis driving new sources for provider non-par or adequacy gap closures and coordination with Regional Access Leads and Markets.

• Lead efforts to proactively communicate network adequacy monitoring results to matrix partners

• Partner closely with Sales segments to support termination management, competitive network requests, performance guarantees, and recruitment enhancement or other needs.

• Drive the creation of actionable information from multiple data sources to support internal and external customers

• Effectively manage team of resources to assist in Network Development, Network Adequacy, Termination Management and Reporting activity

• Coordinate activities with personnel who are also involved in delivering critical Network and provider information. 

• Manages the process to review, interpret, communicate, and collect key information to and from Contracting, Sales, HealthCare Professional Solutions, Corporate work teams and other matrix partners.

• Coordinates and participates in all relevant Access Initiative steering or work team meetings as deemed appropriate.  

• Leads the development of annual targeted Network Development plans in coordination with Regional Access Leads. Works closely with the Medical Recruitment Team (MRT) to plan for needed resources to support efforts. 

• Leads the national termination management  of the pending termination process.  Drive needed enhancements within the department and with matrix partners.

• Identify and escalate risks and formulate recommended solutions nationally.  Must have the ability to drive change in a large, heavily matrixed organization. 

• Business Owner of network access policies for the department

• National lead of alternative network implementations and adequacy monitoring for the Market Network Advisor role driving consistency across markets.  Owns the creation and maintenance of Market Network Advisor job descriptions, training and representation with matrix partners.

• Special projects as required

POSITION REQUIREMENTS

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

• 7+ years Managed Healthcare experience

• 5+ years’ experience within Provider Contracting, Product, Compliance or Provider Network Management, including management of any monitoring activities to ensure provider networks are adequate, required

• 4+ years management experience, required

• Strong database management and analysis background with 3-5 years experience in