26 days old

Medicare Network Operations Manager

Cigna
Bloomfield, CT 06002
  • Job Code
    22026246
GENERAL DESCRIPTION

This position serves as an integral member of the Network Governance& Operations team. This role is accountable for the management of the Medicare Network Operations team and is responsible for provider contract submission and monitoring.

Accountable for the operating results of the Medicare provider network. Establishes specific direction and goals in support of and alignment with overall strategies and objectives to ensure integration and coordination among all functions including, but not limited to Medicare Advantage Network Development teams, Medicare Contracting, Cross Segment Contracting, Operations and Compliance.

DUTIES AND RESPONSIBILITIES

  • Managing and developing the Medicare Network Operations team.
  • Oversight of contract submissions and interface with matrix partners for network implementation and maintenance.
  • Drive all operational inquiries to resolution and central source of operational support.
  • Function as a liaison between internal key matrix partners (PDM, PDQ, Configuration) to ensure delivery of operational excellence.
  • Setup delegation arrangements and data exchanges for new groups.
  • Initiate credentialing
  • Handle CCRs for non-FFS pricing (capitation) or set up VB process with finance
  • Knowledge of network operations such as contract loading, and configuration for network reporting, implementation, and maintenance.
  • Manage agreements that meet internal operational standards and external provider expectations. Ensure accurate implementation / administration through matrix partners.
  • Assist in resolving elevated and complex provider service complaints. Research problems and negotiate with internal/external partners to resolve highly complex and/or escalated issues.
  • Attract, recruit, hire, develop, mentor, coach and retain top talent. Including development of near- and long term business-driven strategic talent plan that ensures continuous, high quality, diverse talent to enable execution of the Medicare growth strategy.

POSITION REQUIREMENTS

  • Degree in health administration, business administration, or another related field and/or equivalent relevant experience in progressively responsible leadership roles focused on managed Medicare and provider engagement.
  • Leadership experience from a large, complex managed care organization, health plan, or provider system with at least three (3) years of innovative Medicare global risk, value-based, and fee-for-service contracting experience.
  • Prior experience leading teams in a non-centralized work environment preferred.
  • Team player with proven ability to develop strong working relationships within a fast-paced, matrix organization.
  • Demonstrates managerial courage and change leadership in a dynamic environment.
  • Superior problem solving, decision-making, negotiating skills, contract language and financial acumen.
  • Working knowledge of provider issues, complex contracting challenges, and regulatory requirements.
  • Experience working with executives and administration of provider entities, IPAs, providers, and contracting teams.
  • Leadership presence, confidence, ability to work well with others, and influence others.
  • 3 or more years of Medicare Advantage and management experience.
  • Ability to assume broader organizational responsibilities as warranted.

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.

For this position, we anticipate offering an annual salary of 80,800 - 134,600 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna .

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.

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.





Posted: 2023-01-10 Expires: 2023-02-08
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Medicare Network Operations Manager

Cigna
Bloomfield, CT 06002

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