Work Location -Must be located in Chicagoland area

The Medicare Advantage Provider Relations Manager (Network Operations Manager), will report to Midwest Network Operations Director, and will be a key member of a cross-functional, cross-collaborative team, including Network Operations, Sales, Health Services, Coding, Finance, Marketing, Stars, and Commercial Contracting.

Please note: This role is NOT IT focused, but will require an individual to work with Provider Groups (Physicians), STARS, Coding, Quality and Value-Based Contracting.

The Network Operations Manager is responsible for providing day to day management and leadership of assigned Network Operations team in the Illinois area in addition to potential new markets. Responsible for effective management of Medicare Advantage provider network in assigned territory, to include:   financial performance, quality/Medicare Star rating program initiatives, provider data accuracy, trend analysis, and provider engagement (particularly, PCPs and key hospital/physician/physician organization partners). Responsible for the development and cultivate key provider partner relationships.  Responsible for developing and executing strategic plans on growth, development, and vision for assigned territory, and for expanding into potential other markets. Presents results for assigned territory at monthly collaborative review with senior leadership. The person shall also assist with the overall managed care contracting strategy by working closely with the Midwest commercial contracting team.

RESPONSIBILITIES

·         Lead and manage assigned Network Operations team in Midwest market to achieve financial and quality performance     

·         Leads the internal partnership with medical economics, legal, health services, Provider Data Management (Cigna Medicare operations) to operationalize contracting by meeting agreed parameters with legal counsel to lessen risk and im

prove   operational efficiencies.

·         As needed, negotiation of managed care contracts including appropriate capitation, fee-for-service reimbursements, and contractual language.

·         Make recommendations regarding participation or non-participation with new or existing agreements. Provide feedback regarding financial and/or operational issues with providers.

·         Participation in bid process, market strategy, compliance, delegation oversight.

·         Support coding and stars initiatives through network operations initiatives and contract negotiations. 

·         Accessible government program knowledge leader for the local market network operations and contracting teams.

·         Lead market initiatives and perform special projects and other duties as assigned by leadership.

REQUIREMENTS

·         Bachelor’s degree or equivalent work experience

·         3 or more years of direct management experience

·         Direct experience with health plan operations start up, preferably specific to government sponsored health plans.

·         3 or more years in Medicare based or Medicare Advantage contracting and negotiating experience involving complex delivery systems, value based contracting, and risk reimbursement

·         3 or more  years in health plan operations management

·         3 or more years demonstrated achievement and progressive responsibilities in the area of provider network operations

This role requires 25% - 50% local travel. You will need to be fully vaccinated in order to travel & meet the requirements for this position. â€‹

This role is Flexible which allows most work to be performed at home or on occasion at a Cigna office location. Employees must be fully vaccinated if they choose to come onsite.

About Cigna

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.