Job Responsibilities : Provider Network Operations Advisor – Work from home – Jackson or Hattiesburg, MS
Salary : $92688 per year
Company : Cigna
Location : Remote US
The Provider Network Operations Advisor serves as an integral member of the Network Operations Market Team and reports to the Senior Manager. The role manages and executes the strategic plan for independent and POD providers in the Mississippi market as well as supervising and partnering with other team members to drive success in the market.
Supporting the development management and oversight of the physician/ provider network in his/her assigned territory
Establishing and managing strong solid relationships with assigned provider groups and their staff (e.g. physicians practice managers care coordination teams) as well as executing with provider group on initiatives that benefit the customer provider and health plan
Assisting in initiatives and performing special projects and other duties as assigned by leadership
Developing time and cost effective territory management in compliance with department and enterprise goals
Understanding developing tracking monitoring and reporting on key program performance metrics such as utilization coding and STARs/quality performance
Partnering with other internal departments including but not limited to Health Services Medical Economics Sales and Coding in order to develop solutions for strategic business needs
May provide guidance to others in the department
Responsible for general oversight and management of provider relationships including but not limited to management of provider network financials pro-forma budget preparation and implementation monthly action plans reviews and verification.
Develops and provides guidance on Provider/POD strategy vision and action plan development for the Cigna managed Providers/PODs.
Responsible for network development including physician contracting rate negotiations network relationships network communication physician recruitment and network partnerships as well as expansion of network and products offered by the plan.
Participates in network and team meetings including physician meetings quality management financial and interdisciplinary team meetings and other committees and projects as necessary.
May manage others and be responsible for their career development.
Local travel in the Mississippi market area up to 40%. Travel may be required for in person business meetings in the Birmingham office three to four times per year.
All market team members contribute to the growth and profitability of the Medicare Advantage business in their market in the following aspects:
Growing the MA Business
The Network Operations External Representative is accountable for the growth of the assigned territory in terms of financial profitability increase in provider network and membership
Delivering our Services
The Network Operations External Representative is accountable for the exceptional delivery of services in the assigned territory as evidenced by physician and member satisfaction improvements on STARS and NPS score.
Managing our Costs
The Network Operations External Representative assists in ensuring the affordability of services in the assigned territory by applying his/her influence where applicable to various cost levers within his/her control
Developing our People
The Network Operations External Representative provides leadership and management across team/s in the assigned territory if applicable or informally mentors team members as appropriate.
Collaborating with our Partners
The Network Operations External Representatives seamlessly collaborates with all applicable partners to ‘solve for Cigna’ and may lead initiatives within his/her that improve service delivery within the business or assist in other special projects.
Education: Bachelor’s degree or equivalent relevant work experience required. Master’s degree; MBA preferred
Direct experience with health plan operations preferably specific to government sponsored health plans
Ability to apply an enterprise mindset with business acumen resulting in meeting goals in growth and profitability
Shows ability to think strategically customer focus and ability to develop strong lasting relationships with providers resulting in deeper collaboration and satisfaction
Capacity for leading initiatives and influencing people on market teams;
Ability to develop strong relationships across multiple levels of the organization
Location: Within 2.5 hrs. of Hattiesburg or Jackson MS
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.
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.
Cigna 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.