Medicare Advantage Value-Based Contracting Regional Director - Cigna Healthcare - Remote

Job Profile: Provider Contracting Senior Advisor

Location: Position will cover the Eastern Region, Preferred Work Location: Maryland, Washington DC, Virginia, Delaware, New Jersey, North Carolina and South Carolina. Travel Required: Up to 25% - local and some overnight regional travel.

The Medicare Advantage Value-Based Contracting Regional Director serves as an integral member of the Medicare Advantage Expansion Provider Contracting Team and reports to the Provider Contracting Director. This role is a key contributor to the development of the strategic direction and is accountable for the management of contracting and network management activities in states across the Eastern Region.

Core Responsibilities

• Experience with leading complex contract negotiations for sophisticated value-based and fee for service agreements with hospitals and other providers (e.g., Hospital systems, Ancillaries, and large physician groups) for one or more geographies.
• Manages strategic positioning for provider contracting, develops networks and identifies and acts upon opportunities for greater value-orientation and risk arrangements.
• Identifying and implementing alternative network initiatives. Supports and provides direction to develop network analytics required for the network solution.
• Proactively builds relationships in expansion territories that nurture provider partnerships and seeks broader value-based business opportunities to support the local market strategy.
• Initiates, nurtures and maintains effective channels of communication with matrix partners including but not limited to, Claims Operations, Medical Management. Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing and Service.
• Responsible for meeting unit cost targets, while preserving an adequate network, to achieve and maintain Cigna's competitive position.
• Identify and manages initiatives that improve total medical cost and quality.
• Drives change with external provider partners by assessing clinical informatics and offering consultative expertise to assist with total medical cost initiatives.
• Prepares, analyzes, reviews, and projects financial impact of high spend or increasingly complex provider contracts and alternate contract terms.
• Creates and / or oversees the development of “HCP” agreements that meet internal operational standards and external provider expectations. Ensures the accurate implementation, and administration through matrix partners.
• Assists in resolving elevated and complex provider service complaints. Researches problems and negotiates with internal/external partners/customers to resolve highly complex and/or escalated issues.
• Manages key provider relationships and is accountable for critical interface with providers and business staff.
• Demonstrates comprehensive knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape.
• Responsible for accurate and timely contract loading and submissions and interface with matrix partners for network implementation and maintenance.

Minimum Requirements

• High School Diploma required; Bachelor degree preferred in the areas of Finance, Economics, Healthcare or Business related. Significant industry experience will be considered in lieu of a Bachelor degree. MBA or MHA preferred.
• 5 or more years of Contracting and Negotiating experience involving complex delivery systems and organizations required; Medicare contracting value based experience required and preferably with expansion expertise. ·
• 3 or more years Value Based Contracting experience required
• Knowledge of complex reimbursement methodologies, including incentive- based models required.
• Prior experience leading project teams in a non-centralized work environment preferred.
• Experience in developing and managing key provider relationships including senior executives.
• Demonstrated experience in seeking out, building and nurturing strong external relationships with provider partners.
• Intimate understanding and experience with larger, more complex integrated delivery systems, managed care, and provider business models.
• Team player with proven ability to develop strong working relationships within a fast-paced, matrix organization.
• The ability to influence both sales and provider audiences through strong written and verbal communication skills. Experience with formal presentations. · Customer centric and interpersonal skills are required.
• Demonstrates managerial courage and change leadership in a dynamic environment.
• Superior problem solving, decision-making, negotiating skills, contract language and financial acumen.
• Knowledge and use of Microsoft Office tools