AVP, Provider Contracting- Cleveland and North Ohio Markets - Hybrid - Cigna Healthcare

Work Location:
Independence, OH - Cleveland area

Hybrid position responsible for the Cleveland and Northern OH market. Will be needed to work 3 days per week in the office.

Assistant Vice President, Provider Network Management, Cleveland and Northern OH (inclusive of Toledo, Akron, Canton, and Youngstown markets)

This position serves as an integral member of the Provider Contracting Team and reports to the Vice President, Network Management, Liberty Valley. This role is a member of the Liberty Valley Network Management leadership team and is accountable for contracting and network management activities for multiple local geographies.

DUTIES AND RESPONSIBILITIES

• Directly manages a contracting team and geography, providing leadership, mentoring, and development opportunities to their direct reports.

• Accountability for managing contracting and network management activity supporting Commercial contracting and other products/initiatives as applicable to market.

• Manages increasingly complex contracts and negotiations for fee for service and sophisticated value-based reimbursements with hospitals and other providers (e.g., Hospital systems, Ancillaries, and large physician groups).

• Leads cross market and cross functional initiatives as needed.

• Proactively builds relationships 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.

• Manages strategic positioning for provider contracting, develops networks and identifies and acts upon opportunities for greater value-orientation and risk arrangements.

• 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.

• Prepares, analyzes, reviews, and projects financial impact of high spend or increasingly complex provider contracts and alternate contract terms.

• Manages key provider relationships and is accountable for 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.

POSITION REQUIREMENTS

• Bachelor’s degree strongly preferred; preferably 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+ years Provider Contracting and Negotiating experience involving complex delivery systems and organizations required.

• Prior experience managing or mentoring direct reports, developing talent, and leading project teams in a non-centralized work environment required.

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

• Knowledge of complex reimbursement methodologies, including incentive models.

• 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.

• 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.

• Able to travel as required

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 provider…