Payor Contracting Strategy Lead – Careallies – Remote

Role Summary

This position has overall accountability for managing the CareAllies’ payor contracting business advisory services related to contracting governance and payor contract negotiations. This role has accountability for executing using CareAllies’ Payor Contracting Standards, compliance and oversight and results in the affordability, patient retention and growth and clinical and financial performance strategies for itself and its clients. This role partners closely with leadership from key matrix partners to develop and implement the Payor Contracting Standards to support CareAllies’ clients’ medical cost improvement and profitable retention and growth, while doing so within contracting standards.

This position is also responsible for ensuring that the results are delivered within CareAllies’ standard contracting requirements across all payors’ lines of business (Commercial, Medicare, Medicaid, ACA) and products (HMO, POS, EPO, OA, PPO etc.). This position is also responsible for creating and iterating on the standards as they support various affordability, retention, growth, and performance initiatives including working with payor contracting, operations and service line leaders to reduce exceptions to those initiatives. This position is also responsible for payor contracting.

Duties & Responsibilities

Negotiation of market competitive payer contracts in terms of rates, structure and language.

Leads the creation, iteration, and application of the CareAllies’ Payor Contracting Standards & Approval requirements for contract negotiators and contract management. Ensures that these Standards do not jeopardize CareAllies’ contracts with clients, internal policies, or standards. Ensures required documentation and analytics are complete prior to review with the client. Facilitates internal and external audit requirements.

Contributes to and executes the direction and evaluation of CareAllies Contracting.

At ease with providing consultative input to CareAllies’ clients regarding matters of contract standards.

Partners closely with leadership from our key matrix partners from Provider Contracting, Operations, Service Line, Medical Economics, etc. in developing and implementing the Contracting Governance supporting medical cost improvement and profitable growth for CareAllies’ clients.

Ensures members of contracting team receive appropriate and continuous training in all aspects ofcontracting standards, including use of current, appropriate, core contract templates; preferredreimbursement standards; contracting policy; and the standard contract process.

Ensures understanding and compliance by contractors with the standard contract process and review of all exceptions to “ability to administer”, financial objectives, policies, and language.

Provides consultative support to contractors on contracting, policy and procedural issues as needed.

Collaborates with Operations to identify and implement a contract management system, processes, and templates.

Supports contracting in maximizing use of system.

Ensure all new contracting employees receive the appropriate training.

Monitors Contract Manager usage in accordance with the established guidelines.

Develop contract language and rate exhibit options for contractors’ use.

Executes/ensures compliance with CareAllies’ Payor Contracting Standards

Drives improvement in clients’ Payor and Patient satisfaction results by driving standardization within contracts leading to lower administrative costs and higher claim service accuracy.

Identifies opportunities for service improvements and cost savings.

Participates in the development of financial plans, business plans and strategy to support administrative, financial, and marketing objectives for clients.

Ensures that Payor contract terms and client provider data is loaded timely and accurately in support of administrative and accuracy objectives

Collaborates with Medical Economics, Operations, Provider Engagement, clients, and other functions such as claim operations, medical management, and legal to share best practices and devise creative solutions to complex problems.

Works with matrix partners to continually review and improve the SARU (Satisfactory, Acceptable, Review-able and Unacceptable) contract standards for all contract types.

Partners closely with the Communication & Education Lead in Provider Engagement to ensure policies and standards are communicated to the field staff appropriately.

Provides input and support to projects (e.g., new service rollouts, regulatory compliance initiatives,etc.) requiring contract content reviews, language compliance assessments and/or provider participationassessments. Works with contracting on language remediation initiatives.

Responsible for People Strategy within their department, including successful execution of all attraction, development, motivation, and retention efforts

Coordinates all budget and expense management activities through effective planning, monitoring, and forecasting

Qualifications:

Bachelor’s Degree; MBA or Master’s Degree in HealthCare Administration or health-related field preferred

Minimum of 10 years managed healthcare experience

Extensive experience (10 years, preferred) in payor, or provider contracting and network development involving multiple payor lines of business, especially Medicare, Commercial and ACA, utilizing value-based care reimbursement methods with physician groups

Excellent negotiation skills

Excellent knowledge of physician and managed care contracting finance for all types of reimbursement and payment methods

Strong knowledge of managed care and practice management (e.g., network design, products, patient services, provider communities, etc.) regulatory environment and compliance issues (e.g., NCQA accreditation issues, credentialing, delegation, and oversight standards, etc.)

Excellent interpersonal and relationship management skills

Excellent oral, written and presentation skills

Proven ability to function in a heavily matrixed environment

Proven ability to foster collaboration, value others perspective and gain support and buy-in for organization proposals

Proven success in managing growth and charge of business operations. Proven ability to drive and lead an organization through significant change

Strong organizational and analytical skills that result in conclusive recommendations

Ability to drive results, think strategically and implement a national strategy

Ability to establish community-based partnerships with providers and other stakeholders

Proficient with Excel, Word, and presentation applications

Technical/Functional expertise: Contracting, Negotiating, Practice Management, Provider Services, Financial Management, Project Management

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.

For this position, we anticipate offering an annual salary of 131,400 – 219,000 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus and long term incentive plan.

We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group .

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.