Full Job Description
Remote, work from home - Jackson or Hattiesburg, MS
Summary:
The Provider Network Operations Advisor serves as an integral member of the Network Operations Market Team and reports to the Senior Manager. The role manages and executes the strategic plan for independent and POD providers in the Mississippi market as well as supervising and partnering with other team members to drive success in the market.
Responsibilities :
Supporting the development, management and oversight of the physician/ provider network in his/her assigned territory
Establishing and managing strong, solid relationships with assigned provider groups and their staff (e.g. physicians, practice managers, care coordination teams), as well as executing with provider group on initiatives that benefit the customer, provider, and health plan
Assisting in initiatives and performing special projects and other duties as assigned by leadership
Developing time and cost effective territory management in compliance with department and enterprise goals
Understanding, developing, tracking, monitoring and reporting on key program performance metrics, such as utilization, coding, and STARs/quality performance
Partnering with other internal departments, including but not limited to Health Services, Medical Economics, Sales, and Coding in order to develop solutions for strategic business needs
May provide guidance to others in the department
Responsible for general oversight and management of provider relationships, including but not limited to management of provider network financials, pro-forma budget preparation and implementation, monthly action plans, reviews, and verification.
Develops and provides guidance on Provider/POD strategy, vision, and action plan development for the Cigna managed Providers/PODs.
Responsible for network development, including physician contracting, rate negotiations, network relationships, network communication, physician recruitment, and network partnerships as well as expansion of network and products offered by the plan.
Participates in network and team meetings, including physician meetings , quality management, financial and interdisciplinary team meetings and other committees and projects as necessary.
May manage others and be responsible for their career development.
Local travel in the Mississippi market area up to 40%. Travel may be required for in person business meetings in the Birmingham office three to four times per year.
Role Components
All market team members contribute to the growth and profitability of the Medicare Advantage business in their market in the following aspects:
Growing the MA Business
The Network Operations External Representative is accountable for the growth of the assigned territory in terms of financial profitability, increase in provider network and membership
Delivering our Services
The Network Operations External Representative is accountable for the exceptional delivery of services in the assigned territory as evidenced by physician and member satisfaction, improvements on STARS and NPS score.
Managing our Costs
The Network Operations External Representative assists in ensuring the affordability of services in the assigned territory by applying his/her influence, where applicable, to various cost levers within his/her control
Developing our People
The Network Operations External Representative provides leadership and management across team/s in the assigned territory if applicable, or informally mentors team members as appropriate.
Collaborating with our Partners
The Network Operations External Representatives seamlessly collaborates with all applicable partners to ‘solve for Cigna’, and may lead initiatives within his/her that improve service delivery within the business or assist in other special projects.
Qualifications:
Education: Bachelor’s degree or equivalent, relevant work experience, required. Master’s degree; MBA, preferred
Direct experience with health plan operations, preferably specific to government sponsored health plans
Ability to apply an enterprise mindset with business acumen resulting in meeting goals in growth and profitability
Shows ability to think strategically, customer focus and ability to develop strong, lasting relationships with providers resulting in deeper collaboration and satisfaction
Capacity for leading initiatives and influencing people on market teams;
Ability to develop strong relationships across multiple levels of the organization
Effective communicator
Location: Within 2.5 hrs. of Hattiesburg or Jackson, MS
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.
About Cigna Healthcare
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.
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.
The Cigna Group 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.
