Director, Provider Contracting - Glendale, CA market (Hybrid)

Cigna • Los Angeles, CA

445d • Hybrid

About The Position

The Director, Provider Contracting plays a crucial role in the Provider Contracting Team, focusing on the strategic direction and management of contracting and network management activities within the Glendale, CA market. This position involves complex negotiations with healthcare providers, fostering relationships, and driving initiatives to improve medical costs and quality of care.

Requirements

• Bachelor's degree in Finance, Economics, Healthcare, or Business-related field; significant industry experience may be considered in lieu of a degree.
• 5+ years of Healthcare Contracting and Negotiating experience with complex delivery systems and organizations.
• Significant experience leading and mentoring others.
• Experience in developing and managing key provider relationships.
• Knowledge of complex reimbursement methodologies, including incentive-based models.
• Demonstrated experience in building and nurturing strong external relationships with provider partners.
• Intimate understanding and experience with hospital, managed care, and provider business models.
• Proven ability to develop strong working relationships within a fast-paced, matrix organization.
• Strong written and verbal communication skills with experience in formal presentations.
• Customer-centric and interpersonal skills are required.
• Demonstrates managerial courage and ability to maneuver effectively in a changing environment.
• Superior problem-solving, decision-making, negotiating skills, contract language, and financial acumen.
• Knowledge and use of Microsoft Office tools.

Responsibilities

• Manages complex contracting and negotiations for fee-for-service and value-based reimbursements with hospitals and other providers.
• May lead a team with direct reports.
• Acts as the point person for complex projects related to contracting strategy in the market.
• Builds relationships that nurture provider partnerships and seeks broader value-based business opportunities.
• Initiates and maintains effective communication with matrix partners including 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 and supports network analytics development.
• Works to meet unit cost targets while preserving an adequate network to 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.
• Prepares, analyzes, reviews, and projects financial impact of larger or complex provider contracts and alternate contract terms.
• Creates agreements that meet internal operational standards and external provider expectations, ensuring accurate implementation and administration.
• Leads in resolving elevated and complex provider service complaints, negotiating with internal/external partners to resolve issues.
• Manages key provider relationships and is accountable for critical interface with providers and business staff.
• Demonstrates knowledge of providers in the assigned geographic area, understanding interrelationships and the competitive landscape.
• Responsible for accurate and timely contract loading and submissions, interfacing with matrix partners for network implementation.

Benefits

• Comprehensive health-related benefits including medical, vision, dental, and well-being 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree