Cigna Lake Mary , FL 32795
Develops, manages, and drives the performance of the physician/provider networks, Including MSOs, IPAs, Independent Primary Care and Specialists, and Facility owned physicians. Develops and implements programs to recruit, service, train, and reimburse physicians and providers. Designs and implements programs to maintain positive relationships between the health plan, physician, providers, and practice managers. Leads as liaison for provider network with internal health plan personnel and initiatives.
Let us tell you a little more. We're a global health service company dedicated to helping people improve their health, well-being and sense of security. But we don't just care about your well-being, we care about your career health too. 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 healthcare.
In conjunction with Market Leadership, develop Cigna-HealthSpring into the business partner of choice within the Orlando service area.
Drive performance and be the key business interface, with physician/provider networks in the Orlando service area.
Detail understanding of the HealthSpring P&L and the operational drivers that affect the results.
Generate, analyze, and articulate / communicate complex data in a meaningful and succinct manner with both internal and external business partners.
Develop action plans that improve business partner performance and strengthen relationships.
Responsible for network development, including physician contracting, rate negotiations, physician network relationships, physician network communication, physician recruitment, and network partners.
Responsible for general oversight of provider network financials, including monthly action plans, reviews, and verification.
Provides guidance to network business partners and leadership on strategic plans, vision, action plan development and implementation for the networks.
Participates in network and company meetings, internal and external, including physician board of directors, quality management, financial analysis.
Analyzes builds and reports to Executive Committee monthly business development of the networks including current status, action plans, successes, fails, and future initiatives and expectations.
Responsible for CMS network maintenance including network adequacy reporting, provider directory data, HSD tables, summary grids, analytics, and/or other regulatory or business requirements.
Maintains collaborative relationship with Cigna Commercial Representatives in overlying geographies/networks.
Responsible for maintaining compliance to CMS and company policies and guidelines.
Responsible for execution of key initiatives, such as CMS STARS.
Build and develop a high performing Network Operations organization and own the career development of team.
Works directly with Chief Operating Officer, Medical Directors, Sales, Marketing, Finance, Medical Economics, Billing, Coding, Health Services, Contracting and Legal to accomplish objectives.
Primarily local travel. Early morning and evening meetings with Physician Networks as needed.
Overnights 8-10 times a year (i.e. Tampa, Nashville, Birmingham).
Valid driver's license, vehicle, and insurance required (mileage reimbursement)
Relationship management and building trust
High degree of financial acumen
Ability to develop win/win scenarios between Cigna HealthSpring and business partners
Ability to use available IT systems to generate meaningful insight to drive business performance
Proven program implementation skills
Possess strong business acumen
Process-oriented with strong organization and planning skills
Strong time management, project management and organization skills with the ability to manage/support multiple projects and priorities
Demonstrated ability to work in a highly-matrixed environment and with all levels
Excellent verbal and written communication skills
Competent in data management, strategic planning/goal setting, and conflict resolution
Technical: Computer skills: Excel, Power Point, Word
Minimum: Bachelor's degree. At least three years related healthcare experience. Previous management experience.
Preferred: Master's Degree & MSO/IPA experience as well as experience in Medicare Advantage, physician relations, managed care, and/or hospital/facility management.