Network Operations/Provider Relations Manager -Medicare (Texas) at Cigna in Houston, Texas

Job Description:

General Summary:  This individual reports directly to the Senior Contracting Manager and will strategically develop and maintain the provider network, ensure positive relationships with providers, and support market leadership in executing growth and cost containment strategy. Will also oversee select day to day functions of the Network Operations department including: negotiating individual and group contracts, maintaining the contractual and operational relationship with providers, analysis and interpretation of medical cost trends, ensuring providers and employees are following compliance guidelines, and supporting projects and activities assigned by market leadership.

Coverage Area: State of Texas

Essential Duties and Responsibilities

Network Development and Maintenance

• Negotiate strategic provider agreements, amendments, and letters of agreement to encourage membership growth and maintain an adequate provider network.


• Formulate and execute value based agreements to achieve quality and financial results.


• Ensure proper contracting correspondence and orientations occur with providers and groups in a timely fashion and in accordance with compliance guidelines.


• Provide regulatory, compliance, and organizational updates to providers and groups.


• Initiates and maintains effective channels of communication with providers, office staff and matrix partners

Financial Review

• Assess cost and growth impact of future contracting efforts and execute agreements based off of leadership recommendations


• Review full network cost trends on a monthly basis, and make tactical contracting decisions based on cost and utilization trends.


• Monitor provider group performance metrics, communicate results to provider groups, and make strategic decisions/recommendations regarding contract progression along value based continuum.


• Develop action plans for outlier cost trend remediation, and engage internal and external partners to achieve results.


• Be prepared to present financial results and action plan status to market leadership.

Team Engagement

• Engage employees in team and one-on-one meetings to share contracting and financial activity updates.


• Hold employees accountable to deadlines, ensure clear, effective employee communication, and provide coaching as needed.


• Intake, interpret, and cascade leadership directives and initiatives; clearly communicate expected action or impact to team members.


• Work in a team oriented fashion involving others within Network Operations as well as other departments.

Other  

• Ensure providers are loaded properly in directory and payment databases.  


• Auditing of rate and demographic data to ensure system accuracy.

• Assists in resolving elevated and complex provider service complaints. Researches problems and negotiates with internal/external partners/customers to resolve escalated and sensitive issues.


• Assist with calls regarding claims payment, appeals, and resolution of operational issues.


• Respond to provider questions, phone calls, and inquiries in a timely fashion.


• Other duties as assigned.

While this job description is intended to be an accurate reflection of the duties involved in this position, the company reserves the right to add, remove or alter duties when business need dictates.

Job Qualifications

At least 5 years health care related work experience required

Bachelor’s Degree strong preferred, High School Diploma Required

Additional Skills:  Excellent presentation, communication and customer service skills required.  Excellent time management and relational skills.  Demonstrated analytical skills. Strong organizational abilities with attention to detail.

Computer Skills: Outlook, Word, Excel, PowerPoint, Share Point

About Cigna

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 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.