Provider Contracting Senior Advisor - Hybrid

This is a hybrid position which will require a weekly schedule of: 3 days working either in office or traveling to in-person meetings with Providers and 2 days working at home/remote.

Summary

National Contracting plays a significant role in The Cigna Group's Enterprise Affordability strategy.  The LifeSOURCE Transplant Network managed by National Contracting is a key growth opportunity for Cigna and play a critical role in delivering affordability and network access for our Customers and Clients. LifeSOURCE consists of over 180 contracted facilities and represents roughly $1B in annual medical spend across US Commercial and US Government and growing.  Heavy focus on controlling unit costs and trends in these contracts are critical for Cigna to achieve Affordability goals. 

The Provider Contracting Senior Advisor is a key role in supporting the company's overall affordability programs, which directly address customer and client demands for lower cost and higher quality of care.  This role will report to the Provider Contracting Director - LifeSOURCE and is accountable for the management of contracting and network management activities for the Northeast region.

Job Components and Deliverables:

DRIVING AFFORDABILITY AND GROWTH

• Responsible for meeting unit cost targets, while preserving an adequate network, to achieve and maintain LifeSOURCE’s competitive position

• Partners with Medical Economics to develop and present affordability opportunities using medical, claims data, financial, and other internal/external data

• Incorporates Industry/Competitive trends in programs/contracts

• Partners with local markets to drive network adequacy and membership growth/persistency strategies

• Partners with Payor Solutions operations to drive new revenue opportunities using the LifeSOURCE network across applicable lines of business

• Contributes to the development of alternative network initiatives. Supports and provides direction to develop network analytics required for the network solution.

• Demonstrates comprehensive knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape.

CONTRACT MANAGEMENT

• Manages increasingly complex contracts and negotiations for transplant and advanced cellular therapy with sophisticated hospitals and physician groups for the assigned geographies.

• Proactively builds relationships that nurture provider partnerships to support the LifeSOURCE strategy

• Negotiates rates and terms on new and existing provider agreements

• Creates LifeSource agreements that meet internal operational standards and external provider expectations

• Identifies and targets new providers to bring in network

• Incorporates contract and compliance standards into provider agreements updates including use of a variety of reimbursement methodologies (fee-for-service, capitation, case rate, DRG, outcomes based adjusted, pay for performance, RBRVS)

• Responsible for contractual/financial performance of LifeSource provider agreements

• Mitigates risk associated with provider performance and termination

MATRIX PARTNER ENGAGEMENT

• Serves as single point of accountability for business relationship to Markets, Product, Clinical, Service Operations,

• Drives education and advocacy across markets and other internal matrix partners

• Contract language interpretation and document preparation to ensure accurate implementation and administration

Qualifications:

• Bachelor’s Degree in Finance or related field highly preferred

• 5+ years of Commercial Contracting and Negotiating experience involving complex delivery systems and organizations

• Strong understanding and experience with hospital, managed care, and provider business models

• Knowledge of transplant hospital contracting is preferred

• 25% regional travel required

• Detailed knowledge of Affordability initiatives and medical spend categories

• Superior problem solving, decision-making, negotiating skills, contract language and financial acumen

• Experience in developing and managing key provider relationships, including senior executives

• Team player with proven ability to develop strong working relationships within a fast-paced, matrix organization

• Knowledge and use of Microsoft Office tools

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 prov