821 HealthSpring Inc

Provider Network Manager

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Job Description

The Medicare Advantage Provider Network Manager will report to the Mountain States Market President 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.

The Provider Network Manager is responsible for providing day to day management and leadership of an assigned Network Operations team. This team member will be responsible for effective management and growth of the Medicare Advantage provider network in assigned territory. Areas of responsibility include developing deep relationships with provider partners, growth initiatives, financial performance, quality performance including STARS, data accuracy, trend analysis, and provider engagement.

Duties and responsibilities

– Responsible for overall provider engagement strategy in Utah and New Mexico for Cigna Medicare Advantage.
– Leads and manages assigned Network Operations team in Utah and New Mexico Medicare markets to meet specific financial and quality performance targets.
– Monitors and provides standardized reporting across a series of key performance indicators including contract status, quality and financial performance, directory accuracy and grievances and appeals.
– Responsible for implementing action plans to resolve any issues related to performance.
– Works closely with STARS and coding teams to ensure optimal performance.
– Makes recommendations regarding participation or non-participation with new or existing agreements.
– Collaborates with the contracting team to ensure the most accurate and timely contracts are in place including consideration of value based agreements.
– Participation in bid process, market strategy, compliance, delegation oversight.
– Leads market initiatives and perform special projects and other duties as assigned by leadership.

Position Requirements

– Bachelor’s degree preferred or equivalent work experience.
– 5 – 7 years of direct management experience.
– Direct experience with health plan provider operations, preferably specific to government sponsored health plans.
– Requires at least 50% travel to network providers.
– Coverage area: Utah and New Mexico
– Car and valid driver’s license required.

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 an accommodation based on your physical or mental disability please email: . Do not email for an update on your application or to provide your resume as you will not receive a response.

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Salt Lake City, Utah Location
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821 HealthSpring Inc