Provider Contracting Director-West Region (Remote)
Regional Director, Contract Management-West Region Position Overview: · Ove r all accountab i lity for ensuring that f i e l d contracto r s comply w it h contract i ng standards , i ncludi n g u se of current core contracts , reimbursement standards , network and c on tr act policy , and t he provide r contract escalation and review process . · Prov i de guidance and support to field contractors on nat i onal standa r ds and use of t h e Con t rac t Management System · Supports f i eld contractors on non-standard i ssues and works close l y w i th the Nationa l Con t ract i ng Standards & Policy team on policy , language , and " ability to admin i ster " issues as well as on repo r tin g and comp l iance with the exception rev i ew process.
Contract Review and Escalation Process: · Work with contractor to develop appropriate response and/or cont r actual language that does not jeopardize Cigna's contracts with employers , i nternal policies or standards . Any language re qu est which could have adverse impact to Cigna i s brought to Contracting Regional Vice President (RVP) for d i scussion and i ntervent i on wi th the provider , if necessary . · Ensure required documentation is comp l ete prior to signature by RVP or Market Lead . · Facilitate internal and external audit requ ir ements .
Training/Contract Standards: · Ensures members of field contracting team r ece i ve appropriate and continuous train i ng i n all aspects of contracting standards , including use of current , appropriate , core contract templates ; preferred reimbursement standards ; national network and contract i ng po li cy ; and the standard contract p r ocess . · Ensures understanding and compliance by fie l d contractors with the standard contract process and r ev i ew of all exceptions to " ability to admin i ster ", financ i al object i ves , policies , and language . · Provides consultative support to field contractors on contracting , po l icy and procedural i ssues as needed.
Contract Management System: · Supports field contracting in maximizing use of system . · Ensure all new employees receive the appropriate tra i ning . · Monitors Contract Manager usage in accordance w i th t he established guidelines . · Develop cont r act language and rate exhibit opt i ons for f i eld use .
Administration : · Collaborates with other RDs, Network Analytics Unit and other national functions such as claim operations , medical management , and legal to share bes t practices and devise creative solutions to complex problems . · Works with national groups to continually review and imp r ove 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 a n d standards are communicated to the field staff appropr i ately.
Policy: · Works closely with Standards & Policy Committee to i dent i fy and r esolve i ssues requ i r i ng c r oss - functional solutions, policymaking and communicat i on . · Provides input and support to national projects ( e . g . new product r o ll -outs , regu l atory compl i ance i n i t i a t ives , etc.) requiring contract content reviews , language compliance assessments and / or networ k part i c i pat i o n assessments .
Works with local contract teams on language remediation i n i tiatives
Qualifications
- 7+ years in Medical Contracting , Negotiating and Provider Serv i ces Ability to foster collaboration , value others perspect i ves and gain suppo r t and buy -i n for organ i zat i onal proposals Matrix management sk i lls. · Ability to drive and lead an organization through change.
- Excellent interpersonal and relationship management skills .
- Excellent oral , written and presentation skills requ i red .
- Strong collaboration , negotiation and leadersh i p sk i lls .
- Strong organizational and analytical skil l s that result i n conc l usive recommendations .
- Ability to think critically with respect to improvement of end-to-end bus i ness process 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.
- 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 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.
- For more details on our employee benefits programs, click here .
- About Cigna Healthcare Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life.
- We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality.
- Join us in driving growth and improving lives.
- 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 need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance.
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- The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible.
- Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment.
- These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
- Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.