DenverRecruiter Since 2001
the smart solution for Denver jobs

Provider Contracting Manager - (Advisor) - New Mexico

Company: Cigna Health and Life Insurance Company
Location: Denver
Posted on: April 11, 2021

Job Description:

Provider Contracting Manager - (Advisor) - New Mexico United States Work at Home This position serves as an integral member of the Provider Contracting Team and reports to the Provider Contracting Senior Manager. This role assists in developing the strategic direction and management of the day to day contracting and network management activities for a local given territory.DUTIES AND RESPONSIBILITIES

  • Manages complex contracting and negotiations for fee for service and value-based reimbursements with hospitals and other providers (e.g., Hospital systems, Ancillaries, and large physician groups).
  • Builds relationships that nurture provider partnerships and seeks broader value-based business opportunities to support the local market strategy.
  • Initiates 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 opportunities for greater value-orientation and risk arrangements.
  • Contributes to the development of alternative network initiatives. Supports and provides direction to develop network analytics required for the network solution.
  • Works to meet unit cost targets, while preserving an adequate network, to achieve and maintain Cigna's competitive position for Cigna's Commercial, Exchange, and Medicare Advantage products.
  • Creates and manages initiatives that improve total medical cost and quality.
  • Drives change with external provider partners by assessing clinical informatics and offering consultative expertise to assist with total medical cost initiatives.
  • Prepares, analyzes, reviews, and projects financial impact of larger or complex provider contracts and alternate contract terms.
  • Creates "HCP" agreements that meet internal operational standards and external provider expectations. Ensures the accurate implementation, and administration through matrix partners.--
  • Assists in resolving elevated and complex provider service complaints. Researches problems and negotiates with internal/external partners/customers to resolve highly complex and/or escalated issues.
  • Manages key provider relationships and is accountable for critical interface with providers and business staff.
  • Demonstrates 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.
  • May provide guidance or expertise to less experienced specialists.POSITION REQUIREMENTS
    • Should possess a bachelor degree; 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.
    • Three to five years contracting and negotiating experience involving complex delivery systems and organizations required.
    • Experience in developing and managing key provider relationships
    • Knowledge of complex reimbursement methodologies, including incentive based models strongly preferred.
    • Demonstrated experience in seeking out, building and nurturing strong external relationships with provider partners.
    • Intimate understanding and experience with hospital, 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. Experience with formal presentations.
    • Customer centric and interpersonal skills are required.
    • Demonstrates managerial courage as well as an ability to maneuver effectively in a changing environment.
    • Superior problem solving, decision-making, negotiating skills, contract language and financial acumen.
    • Knowledge and use of Microsoft Office tools.For this position in Colorado, we anticipate offering an annual salary of 78,000.00, +/- 20%, depending on experience.This role is also anticipated to be eligible to participate in an annual bonus plan.Helping our customers achieve healthier, more secure lives is at the heart of what we do. While you take care of our customers, we'll take care of you through a comprehensive benefits program that helps you be at your best. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and best in class well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and dozens of corporate discounts on essentials you use every day. For more details on our employee benefits programs, please visit the "Life at Cigna" tab on our careersite: www.cigna.com/careers About CignaCigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation.When you work with Cigna, you'll enjoy meaningful career experiences that enrich people's lives while working together to make the world a healthier place. What difference will you make? To see our culture in action, search #TeamCigna on Instagram.Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response. Posted 12 Days Ago Full time 20014211 About Us Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with Cigna, you'll enjoy meaningful career experiences that enrich people's lives while working together to make the world healthier place. What difference will you make? To see our culture in action, search #TeamCigna on Instagram.

Keywords: Cigna Health and Life Insurance Company, Denver , Provider Contracting Manager - (Advisor) - New Mexico, Executive , Denver, Colorado

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Executive Jobs


Regional Sales Manager - Own a Franchise
Description: Own A Franchise br 40 BUSINESS CATEGORIES br PROVEN BUSINESS MODELS br FIND OUT HOW BUSINESS br OWNERS CAN EARN MORE br Have you ever thought about owning your own business If so, now is the (more...)
Company: Franchise Career Advisor
Location: Denver
Posted on: 04/12/2021

Associate Chief Nursing Officer - Hospital Based
Description: Job Summary br br Under minimum supervision, directs the operations and strategic planning of patients/customers services, human resources and financial management for Clinical Nursing areas. Plans, (more...)
Company: Denver Health
Location: Denver
Posted on: 04/12/2021

Nurse Manager- Nursery ICU (NICU)
Description: Job Summary br br Under minimal supervision, the Nurse Manager performs managerial and leadership functions over professional nursing and support care team in various healthcare consumer care settings. (more...)
Company: Denver Health
Location: Denver
Posted on: 04/12/2021


Site Manager
Description: Job DescriptionJob Title: Site Manager br Location: Golden br Environment: Brewery br Pay Rate: 22-25 br br Who is GardaWorld br br GardaWorld is the world's largest privately-owned security (more...)
Company: GardaWorld
Location: Golden
Posted on: 04/12/2021

Operations Management Trainee
Description: Equal Opportunity Employer: Minority/Female/Disability/Veteran br br -- br br Waste Management WM , a Fortune 250 company, is the leading provider of comprehensive waste and environmental services (more...)
Company: Waste Management
Location: Denver
Posted on: 04/12/2021

Licensed Medicare Insurance Agent - State of the Art Lead Management Platform
Description: Considered the gold rush of insurance, Assurance, a Prudential company, is actively looking for independent health insurance agents WITH AHIP certification Residential Insurance License required to (more...)
Company: ASSURANCE Independent Agents
Location: Evergreen
Posted on: 04/12/2021

RN Care Coordinator - Hospital Care Management
Description: Job Summary br br Under general supervision, the RN Care Coordinator is responsible for facilitating and coordinating the care delivered to an assigned group of patients through multidisciplinary (more...)
Company: Denver Health
Location: Denver
Posted on: 04/12/2021

Director Clinical-Post Acute Care
Description: Welcome to Centura HealthJob SummaryResponsible for the overall administration and direction of the Inpatient Hospice Program, and Outpatient Palliative CareProgram, in accordance with Federal, State, (more...)
Company: Centura Health
Location: Denver
Posted on: 04/12/2021

Licensed Medicare Insurance Agent - State of the Art Lead Management Platform
Description: Considered the gold rush of insurance, Assurance, a Prudential company, is actively looking for independent health insurance agents WITH AHIP certification Residential Insurance License required to (more...)
Company: ASSURANCE Independent Agents
Location: Westminster
Posted on: 04/12/2021

Director of Web Development
Description: Our client is adding a Director of Digital Web Development to lead daily business operations on their assigned agency teams. This role is the lead point of contact and communication
Company: Horizontal
Location: Denver
Posted on: 04/12/2021

Log In or Create An Account

Get the latest Colorado jobs by following @recnetCO on Twitter!

Denver RSS job feeds