Medicare Advantage Value-Based Contracting Regional Director - Cigna Healthcare - Remote
About the position
The Medicare Advantage Value-Based Contracting Regional Director plays a crucial role in the Medicare Advantage Expansion Provider Contracting Team, focusing on strategic direction and management of contracting and network activities across the Eastern Region. This position is responsible for leading complex contract negotiations, developing provider networks, and enhancing value-based business opportunities while ensuring effective communication with various internal and external stakeholders.
Responsibilities
Lead complex contract negotiations for value-based and fee-for-service agreements with hospitals and providers.
,
Manage strategic positioning for provider contracting and develop networks to enhance value-orientation and risk arrangements.
,
Identify and implement alternative network initiatives and support network analytics development.
,
Build relationships in expansion territories to nurture provider partnerships and explore value-based business opportunities.
,
Maintain effective communication with matrix partners including Claims Operations, Medical Management, and Compliance.
,
Meet unit cost targets while ensuring an adequate network to maintain competitive positioning.
,
Identify and manage initiatives to improve total medical cost and quality.
,
Drive change with external provider partners by assessing clinical informatics and providing consultative expertise.
,
Prepare, analyze, and project financial impacts of complex provider contracts and alternate terms.
,
Oversee the development of agreements that meet operational standards and provider expectations.
,
Resolve complex provider service complaints and negotiate solutions with partners.
,
Manage key provider relationships and interface with providers and business staff.
,
Demonstrate knowledge of providers in the assigned geographic area and understand the competitive landscape.
,
Ensure accurate and timely contract loading and submissions.
Requirements
High School Diploma required; Bachelor's degree preferred in Finance, Economics, Healthcare, or Business-related fields.
,
5+ years of Contracting and Negotiating experience with complex delivery systems; Medicare contracting value-based experience required.
,
3+ years of Value-Based Contracting experience required.
,
Knowledge of complex reimbursement methodologies, including incentive-based models.
,
Prior experience leading project teams in a non-centralized work environment preferred.
,
Experience in developing and managing key provider relationships with senior executives.
,
Demonstrated ability to build and nurture strong external relationships with provider partners.
,
Understanding of larger, complex integrated delivery systems, managed care, and provider business models.
,
Proven ability to develop strong working relationships in a fast-paced, matrix organization.
,
Strong written and verbal communication skills with experience in formal presentations.
,
Customer-centric and interpersonal skills are required.
,
Demonstrated managerial courage and change leadership in a dynamic environment.
,
Superior problem-solving, decision-making, negotiating skills, and financial acumen.
,
Knowledge and use of Microsoft Office tools.
Nice-to-haves
MBA or MHA preferred.
,
Experience in leading project teams in a non-centralized work environment.
Benefits
Comprehensive health-related benefits including medical, vision, and dental.
,
Well-being and behavioral health programs.
,
401(k) with company match.
,
Company paid life insurance.
,
Tuition reimbursement.
,
Minimum of 18 days of paid time off per year and paid holidays.
Apply Now
The Medicare Advantage Value-Based Contracting Regional Director plays a crucial role in the Medicare Advantage Expansion Provider Contracting Team, focusing on strategic direction and management of contracting and network activities across the Eastern Region. This position is responsible for leading complex contract negotiations, developing provider networks, and enhancing value-based business opportunities while ensuring effective communication with various internal and external stakeholders.
Responsibilities
Lead complex contract negotiations for value-based and fee-for-service agreements with hospitals and providers.
,
Manage strategic positioning for provider contracting and develop networks to enhance value-orientation and risk arrangements.
,
Identify and implement alternative network initiatives and support network analytics development.
,
Build relationships in expansion territories to nurture provider partnerships and explore value-based business opportunities.
,
Maintain effective communication with matrix partners including Claims Operations, Medical Management, and Compliance.
,
Meet unit cost targets while ensuring an adequate network to maintain competitive positioning.
,
Identify and manage initiatives to improve total medical cost and quality.
,
Drive change with external provider partners by assessing clinical informatics and providing consultative expertise.
,
Prepare, analyze, and project financial impacts of complex provider contracts and alternate terms.
,
Oversee the development of agreements that meet operational standards and provider expectations.
,
Resolve complex provider service complaints and negotiate solutions with partners.
,
Manage key provider relationships and interface with providers and business staff.
,
Demonstrate knowledge of providers in the assigned geographic area and understand the competitive landscape.
,
Ensure accurate and timely contract loading and submissions.
Requirements
High School Diploma required; Bachelor's degree preferred in Finance, Economics, Healthcare, or Business-related fields.
,
5+ years of Contracting and Negotiating experience with complex delivery systems; Medicare contracting value-based experience required.
,
3+ years of Value-Based Contracting experience required.
,
Knowledge of complex reimbursement methodologies, including incentive-based models.
,
Prior experience leading project teams in a non-centralized work environment preferred.
,
Experience in developing and managing key provider relationships with senior executives.
,
Demonstrated ability to build and nurture strong external relationships with provider partners.
,
Understanding of larger, complex integrated delivery systems, managed care, and provider business models.
,
Proven ability to develop strong working relationships in a fast-paced, matrix organization.
,
Strong written and verbal communication skills with experience in formal presentations.
,
Customer-centric and interpersonal skills are required.
,
Demonstrated managerial courage and change leadership in a dynamic environment.
,
Superior problem-solving, decision-making, negotiating skills, and financial acumen.
,
Knowledge and use of Microsoft Office tools.
Nice-to-haves
MBA or MHA preferred.
,
Experience in leading project teams in a non-centralized work environment.
Benefits
Comprehensive health-related benefits including medical, vision, and dental.
,
Well-being and behavioral health programs.
,
401(k) with company match.
,
Company paid life insurance.
,
Tuition reimbursement.
,
Minimum of 18 days of paid time off per year and paid holidays.
Apply Now