Cigna Network Operations Admin Manager - Work from home; St. Louis, MO in St. Louis, Missouri
Work from home - St. Louis, MO
Summary: Accountable for supporting the operating results and growth of the Cigna provider network in the St. Louis, MO area. Manages a team of individuals with responsibility for the performance management of the network. This role serves as the liaison between the providers and matrix partners. The Manager will support market strategies and serve as the main point of contact for providers in Cigna’s service area. This position must have a strong knowledge of the market and the provider contracts to ensure proper compliance and execution of the business plan.
This role will manage department goals in support of and alignment with overall strategies and objectives to ensure integration and coordination among all functions including, but not limited to Medicare Advantage network development, value-based contracts, value-based reporting/performance management, credentialing, provider services, delegation, network adequacy, CMS compliance, Stars, and coding.
As a global health service company, our mission is to improve the health, well-being, and peace of mind of those we serve by making health care simple, affordable, and predictable. Our global workforce of more than 74,000 employees are dedicated to living our mission and being champions of our customers and communities each and every day. That’s why when you work with us, you can count on a different kind of career - you’ll make a difference, learn a ton, and share in changing the way people think about health care. We’re making real progress, but we still have work to do. That’s where you come in.
Build and maintain a provider network within your designated territory.
Develop relationships that nurture provider partnerships and execute business plans that support shared savings and global risk / value-based opportunities to support the local market strategy in achieving quality, growth and financial performance targets.
Responsible for managing the Network Operations professional team.
Work to meet unit cost targets while preserving an adequate network to achieve and maintain Cigna's competitive position.
Manage initiatives that improve total medical cost and quality.
Knowledge of network operations such as contract loading, configuration, and provider services for network reporting, implementation, and maintenance.
Execute the market’s HEDIS, CAHPS, and HOS strategy in collaboration with matrix partners in STARS, Coding / Risk Adjustment, and Care Management teams.
Manage agreements that meet internal operational standards and external provider expectations. Ensure accurate implementation / administration through matrix partners.
Assist in resolving elevated and complex provider service complaints. Research problems and negotiate with internal/external partners to resolve highly complex and/or escalated issues.
Support contract negotiations.
Direct appropriate joint operating committee meetings with providers with a focus on key financial, regulatory, and contract performance metrics
Meet network adequacy, affordability, and marketability success metrics.
Collaborate with provider to meet sales annual and open enrollment goals
Attract, recruit, hire, develop, and retain top talent.
Degree in health administration, business administration, or another related field (Master’s Degree desirable) and/or equivalent relevant experience in progressively responsible leadership roles focused on managed Medicare and provider engagement.
Management experience from a managed care organization, health plan, or provider system.
Experience managing major provider contracts. Knowledge of various reimbursement structures and payment methodologies for both hospitals and providers.
Three years of Medicare Advantage experience.
Three years of management experience.
Ability to assume broader organizational responsibilities as warranted.
Ability to travel locally and/or work out of the Cigna office 25% of the time – work from home / remote work flexibility available.
Knowledge of regulatory requirements with emphasis on Medicare Advantage
Value based contracting and performance management
Population health management
Key network connections in the provider community
Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, 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 us, or one of our subsidiaries, you’ll enjoy meaningful career experiences that enrich people’s lives. What difference will you make?
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.