Business Analytics Senior Manager (Total Medical Cost, Provider Contracting & Underwriting) - Evernorth

Business Analytics Senior Manager (Total Medical Cost, Provider Contracting & Underwriting) - Evernorth

Business Analytics Senior Manager (Total Medical Cost, Provider Contracting & Underwriting) - Evernorth

Job Overview

Location
Bloomfield, New Jersey
Job Type
Full Time Job
Job ID
52402
Date Posted
3 months ago
Recruiter
Julia Hart
Job Views
312

Job Description

Summary

The Business Analytics Senior Manager position is an opportunity for an analytics professional to oversee financial analysis and reporting for Total Medical Cost (TMC), Provider Contracting & Contract Underwriting functions and value based arrangement analytical functions for the Connecticut market.

This role will be responsible for understanding key drivers of medical cost results in the market, educating matrix partners, and valuing financial impact of actions to mitigate medical cost. They will partner closely with local Network team to provide analytical, financial, and business support throughout rate negotiations with Hospitals, Ancillaries, and Physician groups. Strategize with Sales, Pricing, Network, and Medical Management teams to develop competitive product offerings for various segments.

The Business Analytics Senior Manager will guide, lead and develop a team of analysts.

This position is with Evernorth, a new business within the Cigna Corporation.

Responsibilities

  • Responsible for executing healthcare provider-level analytics in support of contract negotiation process

  • Responsible for development of, and management to, unit cost and total medical cost plan budgets

  • Responsible for the affordability process and obtaining or maintaining best in class status

  • Communicate the final performance results to the regional and national network leads on the combined fee for service and fee for value

  • Engage with key partners in Sales, Pricing and Network to help develop, execute and maintain new competitive products in the changing healthcare environment

  • Ongoing partnership with Medical Management and Network in identification and communication of cost reduction opportunities and quality improvements via Total Medical Cost analysis

  • Stewardship of data repository, renewal analysis and approvals, and accuracy of reconciliations in support of pricing functions

  • Identify market trends and isolate actions to mitigate the trends – determine if the actions to mitigate trends are best suited to be taken on a market level of a value based model level

  • Provide a holistic view of a provider’s relationship with Cigna rather than the current status quo which is piece meal

  • Communicate with and influence key matrix partners to ensure goals and targets are met

  • Support the development of policies and procedures to ensure adequate controls are in place for the review and signoff of healthcare professional contracts.

  • Drive change initiatives to address prospective business needs. Act as a catalyst through multiple layers to spark enthusiasm, collaboration and results

  • Responsible for day to day management of an analytical team

Qualifications

  • 6+ years' financial experience in the Managed Care industry or Public Health Care; clinical/medical coding knowledge and experience

  • Proven understanding of individual market dynamics (healthcare providers, employers, and competitors, skill/experience in quality/payment innovation programs, health plan performance, etc.)

  • Ability to set strategies/tactics to achieve both cost and quality objectives of Total Medical Cost Management

  • Demonstrated excellence in leadership ability to engage and motivate in a high performance culture

  • Strategic thinker with both sound and broad business acumen

  • Experience working successfully in a matrix environment

  • Previous work experience applying a combination of analytical, technical and business acumen

  • Demonstrated experience in challenging problems and driving outstanding results

  • Proven experience in managing multiple priorities and agility in adapting to change

  • Change leader who will be proactive in assisting in positive growth for the future

  • Knowledge of PPO and managed care environments, including product offerings, risk contracting, competitor offerings and healthcare provider value based reimbursement programs

This role is WAH/Flex which allows most work to be performed at home. Employees must be fully vaccinated if they choose to come onsite.

This position is not eligible to be performed in Colorado.

About Evernorth

Evernorth, Cigna Corporation’s health services segment, exists to elevate health for all. We're building on our legacy and redefining health care as we know it. Unbiased in how we think, we create without limitation. We partner without constraints, deliver value differently and act in the interest of humanity. Solving across silos, closing gaps in care, and empowering clients, customers, and people everywhere to move onward and upward. When you work with us, you’ll be empowered to solve the problems others don’t, won’t or can’t. Join us. 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.

Job ID: 52402

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