What are the responsibilities and job description for the Medicare Provider Performance Lead Analyst- Cigna Healthcare - Hybrid, CO position at The Cigna Group?
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Work Location, Hybrid - Denver, Colorado (must live in/near area)
Job Summary:
The Provider Performance External Representative is a key member of the market that assists in the growth and development of the provider network. The External Representative is the primary conduit to the providers and the individual that represents Cigna MA.
The Provider Performance External Representative’s responsibilities include:
- Supporting the development, management and oversight of the physician/ provider network in his/her assigned territories.
- Establishing and managing strong, solid relationships with assigned provider groups and their staff (e.g. physicians, practice managers, care coordination teams), as well as executing with provider group on initiatives that benefit the customer, provider, and health plan.
- Educating providers on the performance requirements associated with value-based contracts.
- Conducting regular provider visits to educate providers and office staff on topics including, but not limited to: preventative and quality outcome metrics, risk adjustment, medical cost management, etc.
- Schedules, prepares for and participates in meetings with providers, provider staff, and/or physician leadership including creating and delivering presentations.
- Collaborating with Provider Performance Senior Manager/Manager on strategic plans on growth, development, and vision for assigned territory. Participating with the Senior Manager/Manager in monthly financial review.
- Assisting in initiatives and performing special projects and other duties as assigned by leadership
- Developing time and cost effective territory management in compliance with department and enterprise goals.
- Understanding, developing, tracking, monitoring and reporting on key program performance metrics, such as utilization, coding, and Stars/quality performance.
- Partnering with other internal departments, including but not limited to Health Services, Medical Economics, Sales, and Stars & Risk Adjustment in order to develop solutions for strategic business needs
- May provide guidance to others in the department
Core Responsibilities:
All market team members contribute to the growth and profitability of the Medicare Advantage business in their market in the following aspects:
Growing the MA Business
The Provider Performance External Representative is accountable for the growth of the assigned sub-market in terms of financial profitability, engagement of provider network and membership growth.
Delivering our Services
The Provider Performance External Representative is accountable for the exceptional delivery of services in the assigned sub-market as evidenced by physician and member satisfaction, improvements on Stars and NPS score.
Managing our Costs
The Provider Performance External Representative assists in ensuring the affordability of services in the assigned sub-market by applying his/her influence, where applicable, to various cost levers within his/her control.
Developing our People
The Provider Performance External Representative provides leadership and management across team/s in the assigned sub-market if applicable, or informally mentors team members as appropriate.
Collaborating with our Partners
The Provider Performance External Representatives seamlessly collaborates with all applicable partners to ‘solve for Cigna’, and may lead initiatives within his/her area that improve service delivery within the business or assist in other special projects.
Minimum Qualifications:
- Requirements: Bachelor’s degree or equivalent direct experience with health plan operations, preferably specific to government sponsored health plans.
- Ability to apply an enterprise mindset with business acumen resulting in meeting goals in growth and profitability
- Shows ability to think strategically, customer focus and ability to develop strong, lasting relationships with providers resulting in deeper collaboration and satisfaction
- Capacity for leading initiatives and influencing people on teams;
- Ability to develop strong relationships across multiple levels of the organization
- Effective communicator
- Technology Proficient – Microsoft Outlook, PowerPoint, Excel, and Word
This role is also anticipated to be eligible to participate in an annual bonus 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.
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.Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.
