Cigna Careers 2025 – Director, Network Management

Job Description:

This position serves as an integral member of the Medicare Advantage Expansion Provider Contracting Team and reports to the Provider Contracting Senior Manager. This role is a key contributor to the development of the strategic direction and is accountable for the management of the day to day contracting and network management activities in South Florida.

Job Responsibilities:

• Proactively builds relationships in expansion territories that nurture provider partnerships and seeks broader value-based business opportunities to support the local market strategy.
• Initiates and maintains effective channels of communication with matrix partners including but not limited to, Claims Operations, Medical Management. Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing and Service.
• Manages key provider relationships and is accountable for critical interface with providers and business staff.
• Demonstrates knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape.
• Responsible for accurate and timely contract loading and submissions and interface with matrix partners for network implementation and maintenance.
• Meet with providers on a regular basis to ensure the exceptional delivery of quality and service are meeting expectations as evidenced by STARS, NPS, and satisfaction survey scores.
• Manages strategic positioning for provider contracting, develops networks and identifies opportunities for greater value-orientation and risk arrangements.
• Experience with leading complex contracting and negotiations for sophisticated fee for service and value-based reimbursements with hospitals and other providers (e.g., Hospital systems, Ancillaries, and large physician groups).
• Manages strategic positioning for provider contracting, develops networks and identifies opportunities for greater value-orientation and risk arrangements.
• Identifying and implementing the development of alternative network initiatives. Supports and provides direction to develop network analytics required for the network solution.
• Responsible for meeting unit cost targets, while preserving an adequate network, to achieve and maintain Cigna’s competitive position.
• Assist with market’s HEDIS, CAHPS, and HOS strategy in collaboration with matrix partners in STARS, Risk Adjustment, and Care Management teams. Implement data-driven efficiencies for gap closure (e.g. supplemental data feeds, HIE, HL7), and negotiate implementation and usage of record exchange through SFTP site transfers and EMR access.
• Creates and manages initiatives that improve total medical cost and quality.
• Manages the development and provides guidance on strategy, vision, and action plan development for the Cigna Medicare book of business
• Responsible for network development, including contracting, rate negotiations, network relationships, network communication, and network partnerships as well as expansion of network and products offered by Health plan partners

Job Requirements:

• Intimate understanding and experience with hospital, managed care, and provider business models.
• Team player with proven ability to develop strong working relationships within a fast-paced, matrix organization.
• The ability to influence both sales and provider audiences through strong written and verbal communication skills. Experience with formal presentations.
• Customer centric and interpersonal skills are required.
• Demonstrates managerial courage as well as an ability to maneuver effectively in a changing environment.
• Three to five years contracting and negotiating experience involving complex delivery systems and organizations required; Medicare contracting experience required and preferably with expansion expertise.
• Experience in developing and managing key provider relationships
• Knowledge of complex reimbursement methodologies, including incentive based models strongly preferred.
• Demonstrated experience in seeking out, building and nurturing strong external relationships with provider partners.
• Bachelor’s degree strongly preferred; preferably in the areas of Finance, Economics, Healthcare or Business related. Significant industry experience will be considered in lieu of a Bachelor degree. MBA or MHA preferred.

Job Details:

Company:  Cigna

Vacancy Type:  Full Time

Job Location: Sarasota, FL, US

Application Deadline: N/A

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