25 days old

Network Operations Manager

Seattle, WA 98104
  • Job Code
Job Summary:

The Medicare Advantage Network Operations Manager will report to the Pacific Northwest 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.

Candidate must reside within the Seattle, WA area and able to go into the assigned office 3-4 times a week.

The Network Operations Manager is responsible for providing day to day management and leadership of assigned Network Operations team in the Pacific Northwest Market 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 respective geographies commercial contracting team.

Core Responsibilities:

  • Lead and manage assigned Network Operations team in the Seattle, WA 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 improveoperational 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.

Position Requirements

  • Bachelor's degree or equivalent work experience preferred
  • 3-5 years of direct management experience
  • Direct experience with health plan operations start up, preferably specific to government sponsored health plans.
  • 3-5 years in Medicare based or Medicare Advantage contracting and negotiating experience involving complex delivery systems, value based contracting, and risk reimbursement
  • 3-5 years in health plan operations management
  • 3-5 plus yearsdemonstrated achievement and progressive responsibilities in the area of provider network operations
  • Must be willing to (local) travel 25-50%

About Cigna

Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, 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 Cigna, you'll enjoy meaningful career experiences that enrich people's lives while working together to make the world a healthier place. What difference will you make? To see our culture in action, search #TeamCigna on Instagram.

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.

Posted: 2020-09-04 Expires: 2020-10-03
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Network Operations Manager

Seattle, WA 98104

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