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Cigna Medicare Vice President Network Management - Florida in Orlando, Florida

As employees supporting Cigna's Government Business, we believe in doing everything we can to help our customers lead healthier, more secure lives. We advocate for and partner with our customers, providers and stakeholders, and we do this by creating personalized, differentiated, and simpler solutions throughout the customer lifecycle. We strive to maximize the value we deliver through integration with core enterprise capabilities. And, as stewards of taxpayer money, we’re committed to deploying resources wisely. In this way, Cigna’s Government Business seeks to be the undisputed partner of choice for individual and government-sponsored health plans and products. Cigna offers Medicare solutions (Medicare Advantage, Part D, and Medicare Supplemental) within the Government division.

The Medicare Market Vice President, Network Management will lead the development and execution of our Statewide Florida Medicare Advantage network provider strategy, with a focus on the development of relationships, contracting and engagement with our network partners. Success in this role will largely be determined by the ability to develop and communicate the vision for a truly innovative and outcomes-based network growth strategy, considering ever evolving competitive marketplace and provider landscape.

Candidate must reside in Florida to be considered - Central Florida is preferred

RESPONSIBILITIES:

  • Develop the Central Florida provider network and collaborate on statewide provider network growth initiatives, to achieve quality, growth and financial performance targets across HMO and PPO (individual and group) offerings.

  • Implement Florida specific Medicare Advantage provider network strategies, including contracting relationships and innovative value based incentive programs to enable high performing networks measured through quality and affordability, and in pursuit of becoming the undisputed partner of choice.

  • Manages complex contracting with primary care providers, specialists, hospitals, and ancillaries (e.g., Hospital systems and large physician groups).

  • Builds relationships 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, National and local market network Operations, Claims Operations, Medical Management. Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing and Service.

  • Manages strategic positioning for provider contracting, develops networks and identifies opportunities for greater value-orientation and risk arrangements.

  • Contributes to the development of alternative network initiatives. Supports and provides direction to develop network analytics required for the network solution.

  • Works to meet unit cost targets, while preserving an adequate network, to achieve and maintain Cigna's competitive position.

  • Creates and manages initiatives that improve total medical cost and quality.

  • Drives change with external provider partners by assessing clinical informatics and offering consultative expertise to assist with total medical cost initiatives.

  • Prepares, analyzes, reviews, and projects financial impact of larger or complex provider contracts and alternate contract terms.

  • Manages agreements that meet internal operational standards and external provider expectations. Ensures the accurate implementation, and administration through matrix partners.

  • Assists in resolving elevated and complex provider service complaints. Researches problems and negotiates with internal/external partners/customers to resolve highly complex and/or escalated issues.

  • 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.

  • Drive critical network initiatives requiring collaboration across functional areas (e.g., Stars, Risk Adjustment, Health Services, Quality, Utilization Management, Finance, etc.) and Cigna businesses to champion provider investments and optimize network performance.

  • Develop and manage consistent application of analytics and contracting governance processes across market and in partnership with Commercial contracting procedures, including provider communications.

  • Engage with Florida local market Medicare President and Commercial local market to align network strategies, and coordinate network resources.

  • Inspire a collaborative culture while achieving industry leading provider Net Promoter Scores.

  • 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.

QUALIFICATIONS:

  • Degree in health administration, business administration, or another related field (MBA desirable) and/or 15 or more years in a progressively responsible leadership role focused on managed Medicare and provider engagement.

  • Leader from a large, complex managed care organization or provider system with an innovative risk oriented capability with a proven ability to lead a portfolio of markets or business units that is both analytical and customer oriented from a strategic and operational perspective.

  • Demonstrated results in being able to think strategically, anticipate future consequences and trends, and incorporate them into both a short-term and long-term organizational plan.

  • Proven success in developing strategic and operational platforms and leading / mentoring a high-performance management team.

  • Strong influencing and negotiation skills, distribution management, contracting and network savvy, business owner mindset and ability to successfully lead in an ambiguous and changing market with the evolution of healthcare reform, collaborative care and delivery system alliance development and expansion, and the need for governmental influence and savvy.

  • Proven track record of exceeding goals and a bottom-line orientation; evidence of the ability to consistently make good decisions through a combination of analysis, wisdom, experience, and judgment; high level of business acumen, including the ability to balance the delivery of programs against the realities of a budget; allocates resources and manages operating expenses to maximize P&L while managing risk.

  • Effective communicator to executive level staff and external audiences balanced with strong interpersonal skills.

  • Experience building strong and authentic relationships with large health systems and provider groups.

  • Creative problem solving and analytical thinking with a perspective of our provider partners and customers.

  • Experience in business management with responsibility for day-to-day management of short and long-term goals and objectives, health care expenditures, department budgets, and human resource management.

  • Enterprise thinker with proven ability to influence across a matrix environment. Ability to develop relationships across all levels of the organization, as well as externally.

  • Demonstrated ability to manage complex systems and change management across a large organization.

  • A team player with experience in complex matrix environments with the ability to build consensus among divergent interests and competing organizational needs.

  • Capable of effectively messaging detailed value propositions to key stakeholders that blends operational know how and technical skills with market savvy and vision/strategy.

  • Ability to assume broader organizational responsibilities as warranted.

  • 25-35% of local travel required

  • Bilingual Spanish speaker preferred

  • Occasional meetings or trainings in local office several times a month.

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.

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