Medicare Network Operations Director - Chicago, IL at Cigna in Chicago, Illinois

Job Description:

Work Location - Chicago, IL (must live in/or near area)

Summary:

Accountable for the operating results, strategic direction, and growth of the Cigna provider network in the Chicago and Central/Southern Illinois service area. Establishes specific direction and 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.

Why Cigna?

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.

Responsibilities:

• Build and maintain a provider network within your designated territory.


• Develop relationships that nurture provider partnerships and seek broader 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 and developing the Network Operations Professional team.


• Work to meet unit cost targets while preserving an adequate network to achieve and maintain Cigna's competitive position.


• Key member of the Medicare Advantage product's CMS bid/filing.


• Create and 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.


• Assist with 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.


• Oversees assessment of provider network adequacy, financial impact analysis for health plan and new and/or potential providers, and education materials and programs.


• Strategic lead for network performance with line of sight into P&L metrics.


• Negotiates fees and contract terms for the provision of health services from external vendors/ organization.


• 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.


• Matrixed oversight of sales annual and open enrollment performance


• Attract, recruit, hire, develop, mentor, coach and retain top talent. Including development of near- and long term business-driven strategic talent plan that ensures continuous, high quality, diverse talent to enable execution of the Medicare growth strategy.

Minimum Requirements:

• 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.


• Leadership experience from a large, complex managed care organization, health plan, or provider system with at least three (3) years of innovative Medicare global risk, value-based, and fee-for-service contracting experience.


• Working knowledge of provider issues and competitor strategies, complex contracting options, financial/contracting arrangements and regulatory requirements.


• Experience managing and negotiating major provider contracts. In-depth knowledge of various reimbursement structures and payment methodologies for both hospitals and providers.


• Three to five years of Medicare Advantage experience.


• Three to five years of management experience.


• Ability to assume broader organizational responsibilities as warranted.


• Flexible work location - will be required to be in the office 5 - 10 days a month.

Preferred Requirements:

• CMS background


• Knowledge of regulatory requirements with emphasis on Medicare Advantage


• Value based contracting and performance management


• Global risk contracting


• Delegation


• Physician Engagement


• Medicare Advantage product filing


• Population health management


• Key network connections in the provider community

About Cigna

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.