Network Operations Advisor

Where You'll Work

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 healthier place. What difference will you make?

This role will work with a subdivision within Cigna called CareAllies. CareAllies is a Management Company that works side-by-side with providers and payer entities to help improve the quality, value and the experience of care for patients, to make health care better for everyone. As a part of the Provider Engagement Team, you will be working closely with providers to accelerate their transition to value-based care and to help them manage the long-term health of their patients. CareAllies' consultative approach emphasizes physician engagement, delivery system organization and culture change, actionable data and analytics, as well as patient engagement to support treatment plans. We collaborate with providers to drive change and ensure success in a value-based market.

What You'll Do

CareAllies Provider Engagement Lead Analyst is designed for someone to develop management skills and provide experience working in a dynamic, flexible work environment. In this role you will lead a team of Internal Representatives a crossed the CareAllies organization. You will guide and educate the team to deliver the needed support services for our clients. The Provider Engagement Advisor role offers:

Roles and Responsibilities

• Develops and maintains positive relationships with physicians, providers, and practice managers within the network, including oversight and managing performance in various incentives based and/or value based programs. Including but not limited to management of provider network financials, pro-forma budget preparation and implementation, monthly action plans, reviews, and verification.
• Develops and maintains positive relationships with physicians, providers and practice manager, provider office staff to research and resolve claims issues in a timely.
• Prepare materials and presents materials to Board of directors of assigned IPA/VBCA.
• Develops and provides guidance on IPA/VBCA strategy, vision, and action plans development for the CareAllies Managed IPA/VBCA.
• Perform root cause analyses & resolution related to provider concerns, grievances, claims and care delivery
• Create and deliver materials to educate providers and provider staff on contracts, policies and procedures, quality and service line initiatives, and financial performance.
• Tracks and monitors and reports on key program performance metrics, such as utilization, coding, and STARs/quality performance.
• Participates in Monthly leadership meetings where presentations may be required on Department status
• Responsible for general oversight and management of Independent Physician Associations (IPAs) relationships. Including but not limited to management of provider network financials, pro-forma budget preparation and implementation, monthly action plans, reviews, and verification.
• May manage a single Lead Analyst, Senior Analyst, Analysts and/or Associate Analyst position and is responsible for the career development of the person.

Qualifications

What you need to do the job

• Bachelor's Degree
• Extensive knowledge of health insurance industry, terminology, provider networks, contracting and credentialing highly preferred
• Experience in physician relations or managed care.
• Previous people management experience strongly preferred
• Excellent communication skills - verbal, written and presentation.
• Expert level of Excel preferred (knowledge of pivot tables, VLOOKUP, etc.)
• Team player with proven ability to foster and manage working relationships within a matrix environment to obtain buy-in and drive results.
• Creative independent thinker with ability to think outside the box and translate ideas into actions
• Strong analytical and problem solving skills

Additional Information

• Location: Philadelphia, PA and Baltimore, MD
  • 50% local travel required to providers in office geography.
  • Travel to out of state conferences and meetings 3-4 times per year.
• Work Designation: This role is a Flex role, which requires a combination of in-office days, WAH, and field work. Car and Valid Driver's License is required (mileage reimbursement provided)
• Schedule: In this role you will need to attend meetings with providers. These meetings are held at clients convenience, which can include early morning (7am) or evening (6pm). Schedule is provided in advance and you will be asked to support occasional weekend conferences (2 x year).

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: [email protected] for support. Do not email [email protected] 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.