Job Description

Remote, work from home - Dallas/Fort Worth, TX (must live in /near area)

Summary:

This individual reports directly to the department senior manager and is responsible for executing strategy to optimize performance of the Medicare Advantage network in the assigned geography. This includes maximizing quality KPIs, supporting market leadership in executing growth and cost containment strategies, and ensuring positive relationships with providers.

Will be responsible for oversight of a team that will manage provider network performance within an assigned geography in Texas and/or Oklahoma. The team will track and analyze performance metrics including overall MA membership growth, medical loss ratio reduction through analysis of medical cost trends, ensuring Medicare STARs gaps are closed, and documentation of accurate patient coding. The Senior Manager will develop initiatives to meet market goals and ensure team members execute on those initiatives. Collaboration between team members and organizational matrix partners is a must.

Market Coverage Area: Dallas/ Fort Worth and other areas as assigned

Local Travel - 25% or less, mileage reimbursement provided
Responsibilities:

• Contribute to build overall market strategy, and develop methods to execute that strategy with teammates and matrix partners.
• Oversee network operations and prioritize approach to value based and FFS providers to maximize market performance.
• Develops and maintains communication and reporting channels with provider group partners to ensure timely delivery of data and results.
• Initiates and maintains effective channels of communication with providers, office staff and matrix partners with identification of issues and efficient resolution.

• Internal review and reporting of provider group and network performance trends on a monthly basis, with development of action plans for outlier utilization and cost trend remediation, and convenes internal and external partners to achieve results.
• Make strategic decisions/recommendations regarding contract progression along value based continuum.
• Challenges team members to solve problems creatively and engages in open discussion. Removes barriers so employees feel empowered to share and execute on ideas.

• Holds employees accountable to compliance requirements, deadlines, and ensure clear and effective employee communication; provides coaching as needed.
• Understands organizational priorities and creates a learning and knowledge management strategy/roadmap, plans, and training to achieve knowledge objectives.

Qualifications:

• Bachelor\'s Degree or equivalent, relevant work experience
• Work experience - 5 or more years
• Experience with provider operations and/or strategies highly desirable
• Excels at developing high performing teams
• Demonstrated ability to lead teams through change
• Demonstrated ability to both effectively execute against high level organizational strategies as well as at detailed / technical levels
• Ability to foster collaboration, value others perspectives and gain support and buy-in for organizational proposals.
• Ability to drive to results independently.
• Excellent oral, written presentation and communication skills.
• Proven ability to create and further develop strong relationships with leadership.

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.

eQuest