Provider Contracting, Senior Advisor (Transplant) - Cigna Healthcare - Remote

📋 Description

• • As a Provider Contracting Senior Advisor specializing in Transplant at Cigna Healthcare, you will play a pivotal role in shaping the future of our LifeSource Transplant Network, a critical component of our affordability and growth strategies. This network encompasses over 180 contracted facilities and manages approximately $1 billion in annual medical spend, making your contributions directly impactful to the company's financial health and patient care.
• • Your primary focus will be leading provider contracting and network management initiatives for transplant and advanced cellular therapy providers specifically within the Northeast region. This involves navigating complex negotiations, ensuring cost containment, and maintaining a high standard of network access for our members.
• • This is a hybrid position, offering the flexibility of remote work while also requiring your presence in the office and/or travel for in-person provider meetings, ensuring a balanced approach to collaboration and engagement.
• • You will be instrumental in driving unit cost targets by developing and maintaining a robust and competitive transplant network. This requires a deep understanding of market dynamics and provider capabilities.
• • A key aspect of your role will be partnering closely with the Medical Economics team to identify and capitalize on affordability opportunities. This will involve leveraging claims data, financial reports, and market intelligence to inform strategic decisions.
• • You will continuously monitor industry trends and competitive landscapes to refine and adapt our contracting strategies, ensuring Cigna Healthcare remains at the forefront of provider network management.
• • Collaboration with local market teams is essential to support network adequacy and drive membership growth, ensuring our network meets the needs of our expanding member base.
• • You will also contribute to the development and implementation of innovative and alternative network initiatives, exploring new models for care delivery and reimbursement.
• • Leading complex contract negotiations with transplant and advanced cellular therapy hospitals and physician groups will be a core responsibility. This includes negotiating rates, terms, and amendments for both new and existing agreements.
• • You will be responsible for developing contracts that not only meet Cigna Healthcare's operational requirements but also align with provider expectations and foster strong partnerships.
• • Identifying and onboarding new, high-quality providers is crucial for strengthening and expanding the LifeSource network, ensuring comprehensive coverage and access to specialized care.
• • A strong understanding and application of multiple reimbursement models, including case rates, Diagnosis-Related Groups (DRGs), fee-for-service, and value-based arrangements, will be necessary to structure effective agreements.
• • You will actively monitor the contractual and financial performance of providers, proactively identifying and mitigating any associated risks to ensure the network's stability and efficiency.
• • Serving as the primary point of contact for internal partners across Markets, Product, Clinical, and Operations teams is vital. You will provide expert guidance on contract interpretation and facilitate smooth implementation processes.
• • You will take the lead in resolving escalated provider issues, ensuring timely and satisfactory resolutions that maintain positive relationships.
• • Building and nurturing strong, collaborative relationships with both providers and internal stakeholders will be fundamental to your success in this role.
• • This role demands a strategic mindset, exceptional negotiation skills, and a commitment to achieving Cigna Healthcare's goals in provider network management and healthcare affordability.