Director, Network Management

This is a fully remote position, open to applicants in Idaho.

📋 Description

• Oversees intricate contracting processes and negotiations for fee-for-service and value-based reimbursements with hospitals and various providers (e.g., hospital systems, ancillaries, and large physician groups).

• May supervise a team with direct reports.

• Acts as the primary contact for complex projects concerning contracting strategies within the market.

• Cultivates relationships that enhance provider partnerships and seeks expanded value-based business opportunities to bolster the local market strategy.

• Initiates and sustains effective communication channels 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 opportunities for enhanced value orientation and risk arrangements.

• Contributes to the formulation of alternative network initiatives.

• Supports and directs the development of network analytics necessary for the network solution.

• Strives to achieve unit cost targets while maintaining an adequate network to uphold Cigna's competitive stance.

• Creates and administers initiatives that enhance total medical cost and quality.

• Drives change with external provider partners by evaluating clinical informatics and providing consultative expertise to assist with total medical cost initiatives.

• Prepares, analyzes, reviews, and forecasts the financial impact of larger or more complex provider contracts and alternative contract terms.

• Develops “HCP” agreements that align with internal operational standards and external provider expectations.

• Ensures accurate implementation and administration through matrix partners.

• Leads efforts in resolving elevated and complex provider service complaints.

• Investigates problems and negotiates with internal/external partners/customers to address highly complex and/or escalated issues.

• Manages key provider relationships and is responsible for critical interactions with providers and business staff.

• Demonstrates knowledge of providers within a designated geographic area by understanding the interrelationships and the competitive landscape.

• Responsible for the accurate and timely loading and submission of contracts and collaboration with matrix partners for network implementation and maintenance.

⛳️ Requirements

• A bachelor's degree is required, preferably in Finance, Economics, Healthcare, or a related Business field.

• Significant industry experience may be considered in lieu of a bachelor's degree.

• An MBA or MHA is preferred.

• A minimum of 5 years of experience in contracting and negotiating with complex delivery systems and organizations is required.

• Extensive experience in leading and mentoring others.

• Proven experience in developing and managing key provider relationships.

• Strong knowledge of complex reimbursement methodologies, including incentive-based models, is highly preferred.

• Demonstrated ability to seek out, build, and maintain strong external relationships with provider partners.

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

• A team player with a proven track record of establishing strong working relationships within a fast-paced, matrix organization.

• Ability to influence both sales and provider audiences through effective written and verbal communication skills.

• Experience delivering formal presentations.

• Strong customer-centric and interpersonal skills are essential.

• Exhibits managerial courage and the ability to navigate effectively in a dynamic environment.

• Exceptional problem-solving, decision-making, negotiating skills, contract language proficiency, and financial acumen.

• Proficient in the use of Microsoft Office tools.

🏝️ Benefits

• Health insurance

• 401(k) matching

• Paid time off

• Flexible work arrangements

• Professional development opportunities