Medicare Provider Performance Enablement Advisor - Cigna Healthcare - Hybrid

This role aligns to the Georgia market, incumbent candidate will work from local office 3 days per week.

The Provider Performance Enablement Advisor is an integral part of a cross-functional, collaborative organization (which includes Market Provider Performance, Sales, Clinical Operations, Stars & Risk Adjustment, Finance , Cross-Segment Contracting, Provider Relations, and Network Development & Solutions). Reporting to the Network Operations Senior Manager or Director, this individual ensures the effective performance management of the provider network for his/her assigned sub-market and/or provider groups. The role of Senior Advisor with the Provider Performance Enablement team takes ownership for performance outcomes of the most complex relationships within the market.  Often this includes multi-site health systems and national primary care clinic partners.

The Provider Performance Enablement Advisor’s responsibilities include:

• Developing and managing the local physician/provider network, engaging with providers and internal stakeholders to drive high performance in quality and cost efficiency, designing and implementing programs to maintain positive relationships between the health plan, physician, providers, and practice managers.
• Responsible for oversight of provider group financials, including monthly action plans, reviews, and verification as it relates to value based incentive contracts and performance.
• Providing feedback and recommendations regarding participation or non-participation with new or existing agreements and financial and/or operational issues with providers.
• Leading Stars & Risk Adjustment outcomes through local Provider Performance initiatives. Developing and implementing programs to achieve enhanced quality and affordability through physician education, training and provision of reporting and  using analytics resources to identify key opportunities for utilization and cost management.
• Acting as government program knowledge leader for the local market.
• Responsible for maintaining compliance to CMS and company policies and guidelines.
• Leading market initiatives and performing special projects and other duties as assigned by leadership.

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 Senior Advisor is accountable for the growth of the assigned market in terms of financial profitability, and Star rating performance.

Delivering our Services:

The Provider Performance Senior Advisor is accountable for the exceptional delivery of services in the assigned market as evidenced by physician and member satisfaction, improvements on Star Rating and NPS score.

Managing our Costs:

The Provider Performance Senior Advisor ensures the affordability of services in the assigned market by effective control of various cost levers.

Developing our People:

The Provider Performance Senior Advisor provides informal leadership across team/s in his/her assigned market. He/she supports the effective coaching across Provider Performance Enablement team.

Collaborating with our Partners:

The Provider Performance Senior Advisor seamlessly collaborates with all applicable partners to ‘solve for Cigna’, and may lead cross-market initiatives that improve service delivery within the business.

Qualifications and Competencies

• Education:  Bachelor’s degree required; Master's degree preferred
• Experience: Previous provider relationship field experience; preferred at least five (5) years direct experience with government sponsored health plans
• Ability to apply an enterprise mindset with business acumen resulting in meeting or exceeding goals in growth and profitability
• Demonstrate strategic thinking, customer focus and proven ability to develop strong, lasting relationships with providers resulting in deeper collaboration and satisfaction  
• Capacity for leading initiatives and influencing people on market teams; ability to drive transparency and accountability, and learn the strengths and weaknesses of the team so as to inform leadership to put people in a position to succeed
• Ability to develop strong relationships across multiple levels of the organization
• Effective communicator
• Location:  Strongly preferred aligned to Cigna worksite within assigned territory with in-territory travel expected often.

Technology Proficie