Provider Contracting Director – West Region

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

📋 Description

• Overall responsibility for ensuring that field contractors adhere to contracting standards, which include the use of current core contracts, reimbursement standards, network and contract policies, as well as the provider contract escalation and review process.

• Offer guidance and support to field contractors regarding national standards and the utilization of the Contract Management System.

• Assist field contractors with non-standard issues and collaborate closely with the National Contracting Standards & Policy team on matters related to policy, language, and "ability to administer" issues, in addition to reporting and compliance with the exception review process.

• Collaborate with contractors to formulate appropriate responses and/or contractual language that safeguard Cigna's agreements with employers, along with internal policies or standards.

• Ensure all required documentation is finalized before obtaining signatures from RVP or Market Lead.

• Facilitate internal and external audit requirements.

• Guarantee that members of the field contracting team receive appropriate and ongoing training in all facets of contracting standards, including the use of current, suitable core contract templates; preferred reimbursement standards; national network and contracting policy; and the standard contract process.

• Ensure that field contractors comprehend and comply with the standard contract process and review all exceptions concerning "ability to administer," financial goals, policies, and language.

• Provide consultative support to field contractors on contracting, policy, and procedural matters as necessary.

• Assist field contracting in optimizing system utilization.

• Ensure that all new employees receive the necessary training.

• Monitor Contract Manager usage in alignment with established guidelines.

• Develop contract language and rate exhibit options for field application.

• Collaborate with other RDs, the Network Analytics Unit, and other national functions such as claims operations, medical management, and legal to share best practices and create innovative solutions to complex issues.

• Work with national groups to consistently evaluate and enhance the SARU (Satisfactory, Acceptable, Reviewable and Unacceptable) contract standards for all contract types.

• Partner closely with US Medical Network Contracting Readiness to ensure that policies and standards are effectively communicated to field staff.

• Collaborate closely with the Standards & Policy Committee to identify and address issues that require cross-functional solutions, policymaking, and communication.

• Provide insights and support for national projects (e.g., new product launches, regulatory compliance initiatives, etc.) that necessitate contract content reviews, language compliance assessments, and/or network participation evaluations.

• Work alongside local contract teams on language remediation initiatives.

⛳️ Requirements

• 7+ years of experience in Medical Contracting, Negotiating, and Provider Services.

• Proven ability to promote collaboration, value diverse perspectives, and secure support and buy-in for organizational proposals.

• Strong matrix management capabilities.

• Ability to drive and lead an organization through periods of change.

• Exceptional interpersonal and relationship management skills.

• Outstanding oral, written, and presentation abilities are required.

• Strong collaboration, negotiation, and leadership skills.

• Excellent organizational and analytical skills that lead to definitive recommendations.

• Capacity to think critically regarding the enhancement of end-to-end business processes.

🏝️ Benefits

• Medical, vision, dental, and well-being and behavioral health programs.

• 401(k) plan.

• Company-paid life insurance.

• Tuition reimbursement.

• A minimum of 18 days of paid time off annually.

• Paid holidays.

• Leaves of absence.