Director, Provider Contracting - Houston, Austin or San Antonio, TX

About the position

The Provider Contracting Advisor position at Cigna Healthcare is a pivotal role within the Provider Contracting Team, designed to enhance the strategic direction and management of contracting and network management activities within a specified local territory. This position is integral to the development of relationships with hospitals, physician groups, and other providers, focusing on both fee-for-service and value-based reimbursement models. The advisor will be responsible for managing complex negotiations and contracts, ensuring that they align with Cigna's competitive positioning and overall market strategy. In this role, the advisor will build and maintain effective communication channels with various internal partners, including Claims Operations, Medical Management, Credentialing, Legal, and Compliance. The advisor will also contribute to the development of alternative network initiatives and support the creation of network analytics necessary for effective network solutions. A key responsibility will be to drive initiatives that improve total medical costs and quality, leveraging clinical informatics to assist external provider partners in achieving these goals. The advisor will prepare and analyze financial impacts of complex provider contracts, ensuring that all agreements meet both internal operational standards and external provider expectations. This includes managing key provider relationships, resolving complex service complaints, and ensuring accurate contract loading and submissions. The role may also involve providing guidance to less experienced specialists, fostering a collaborative environment within a fast-paced, matrix organization.

Responsibilities
? Manage complex contracting and negotiations for fee-for-service and value-based reimbursements with hospitals and other providers.
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? Build relationships that nurture provider partnerships and seek broader value-based business opportunities.
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? Initiate and maintain effective communication with matrix partners including Claims Operations, Medical Management, Credentialing, Legal, and Compliance.
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? Manage strategic positioning for provider contracting and develop networks to identify opportunities for greater value-orientation and risk arrangements.
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? Contribute to the development of alternative network initiatives and support network analytics.
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? Work to meet unit cost targets while preserving an adequate network to maintain Cigna's competitive position.
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? Create and manage initiatives that improve total medical cost and quality.
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? Drive change with external provider partners by assessing clinical informatics and offering consultative expertise.
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? Prepare, analyze, review, and project financial impact of larger or complex provider contracts.
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? Create agreements that meet internal operational standards and external provider expectations.
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? Ensure accurate implementation and administration of contracts through matrix partners.
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? Assist in resolving elevated and complex provider service complaints.
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? Research problems and negotiate with internal/external partners to resolve complex issues.
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? Manage key provider relationships and interface with providers and business staff.
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? Demonstrate knowledge of providers in the assigned geographic area and understand the competitive landscape.
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? Ensure accurate and timely contract loading and submissions for network implementation and maintenance.

Requirements
? Bachelor's degree in Finance, Economics, Healthcare, or Business-related field; significant industry experience may be considered in lieu of a degree.
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? MBA or MHA preferred.
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? 3+ years of contracting and negotiating experience involving complex delivery systems and organizations.
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? Experience in developing and managing key provider relationships.
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? Knowledge of complex reimbursement methodologies, including incentive-based models.
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? Demonstrated experience in building and nurturing strong external relationships with provider partners.
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? Intimate understanding of hospital, managed care, and provider business models.
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? Proven ability to develop strong working relationships within a fast-paced, matrix organization.
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? Ability to influence sales and provider audiences through strong written and verbal communication skills.
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? Experience with formal presentations.
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? Customer-centric and interpersonal skills are required.
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? Demonstrates managerial courage and ability to maneuver effectively in a changing environment.
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? Superior problem-solving, decision-making, negotiating skills, contract language, and financial acumen.
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? Knowledge and use of Microsoft Office tools.

Nice-to-haves
? Experience in managed care sales.
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? Familiarity with healthcare systems and regulations.

Benefits
? Smoking cessation program
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? Health insurance
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? 401k plan
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? Paid holidays
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? Flexible scheduling options
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? Professional development opportunities

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