Provider Contracting Director

Role Description

The job profile for this position is Provider Contracting Director, which is a Band 5 Management Career Track Role.

Excited to grow your career? We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply! Our people make all the difference in our success.

Position Overview:

• Overall accountability for ensuring that field contractors comply with contracting standards, including use of current core contracts, reimbursement standards, network and contract policy, and the provider contract escalation and review process.
• Provide guidance and support to field contractors on national standards and use of the Contract Management System.
• Supports field contractors on non-standard issues and works closely with the National Contracting Standards & Policy team on policy, language, and "ability to administer" issues as well as on reporting and compliance with the exception review process.

Contract Review and Escalation Process:

• Work with contractor to develop appropriate response and/or contractual language that does not jeopardize Cigna's contracts with employers, internal policies or standards.
• Ensure required documentation is complete prior to signature by RVP or Market Lead.
• Facilitate internal and external audit requirements.

Training/Contract Standards:

• Ensures members of field contracting team receive appropriate and continuous training in all aspects of contracting standards, including use of current, appropriate, core contract templates; preferred reimbursement standards; national network and contracting policy; and the standard contract process.
• Ensures understanding and compliance by field contractors with the standard contract process and review of all exceptions to "ability to administer", financial objectives, policies, and language.
• Provides consultative support to field contractors on contracting, policy and procedural issues as needed.

Contract Management System:

• Supports field contracting in maximizing use of system.
• Ensure all new employees receive the appropriate training.
• Monitors Contract Manager usage in accordance with the established guidelines.
• Develop contract language and rate exhibit options for field use.

Administration:

• Collaborates with other RDs, Network Analytics Unit and other national functions such as claim operations, medical management, and legal to share best practices and devise creative solutions to complex problems.
• Works with national groups to continually review and improve the SARU (Satisfactory, Acceptable, Review-able and Unacceptable) contract standards for all contract types.
• Partners closely with US Medical Network Contracting Readiness to ensure policies and standards are communicated to the field staff appropriately.

Policy:

• Works closely with Standards & Policy Committee to identify and resolve issues requiring cross-functional solutions, policymaking and communication.
• Provides input and support to national projects (e.g. new product roll-outs, regulatory compliance initiatives, etc.) requiring contract content reviews, language compliance assessments and/or network participation assessments.
• Works with local contract teams on language remediation initiatives.

Qualifications

• 7+ years in Medical Contracting, Negotiating and Provider Services.
• Ability to foster collaboration, value others perspectives and gain support and buy-in for organizational proposals.
• Matrix management skills.
• Ability to drive and lead an organization through change.
• Excellent interpersonal and relationship management skills.
• Excellent oral, written and presentation skills required.
• Strong collaboration, negotiation and leadership skills.
• Strong organizational and analytical skills that result in conclusive recommendations.
• Ability to think critically with respect to improvement of end-to-end business process.

Requirements

• If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

Benefits

• For this position, we anticipate offering an annual salary of 156,700 - 261,100 USD / yearly, depending on relevant factors, including experience and geographic location.
• This role is also anticipated to be eligible to participate in an annual bonus plan and long term incentive plan.
• At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health.
• Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs.
• We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence.

Company Description

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.

Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.