Provider Liaison - Evernorth - Hybrid

We are seeking a Provider Liaison for the Houston market focusing on home-based healthcare provider and medical services. The team is an innovative, multi-specialty practice who is experiencing tremendous growth nationwide.  Our focus is comprehensive care at home to improve outcomes and reduce total healthcare costs.  We are a group of clinical professionals that understand the needs of our patients, medical professionals, and the health systems.

What you must have

• Bachelor’s degree and/or equivalent work experience

• 3-5 years in Managed Care and/or Provider Contracting and/or Provider Relations, highly preferred.

• Knowledge of healthcare provider relations, provider network systems, contracting and credentialing requirements, contracts, and terminology.

• Knowledge of Provider onboarding process, system applications, and procedures.

• Ability and willingness to share knowledge as well as train, develop, and coach individuals with varying levels of experience. 

• Detail oriented, with proven time management and organization skills (including the ability to engage in multiple tasks and meet deadlines/standards).

• Act with a sense of urgency to research questions or issues brought by the team. Identify the right parties or resources to resolve these issues.  Follow up with these parties to drive resolution and provide on-going feedback to individual(s) who raised the question or issue.

• Positive role model and have the ability to work independently and in conjunction with co-workers of all levels.

• Strong negotiation, presentation, analytical and problem-solving skills.

• Excellent communication skills – verbal, written and presentation.

• Working knowledge of Microsoft Office.

• Ability to quickly learn and master basic contracting platforms and databases.

Duties and Responsibilities

• Establish and maintains strong relationships with local/regional health providers within the assigned territory including PCPs & Specialists, hospitals, step down facilities, health systems, ancillary and pertinent community-based resources.

• Provide education and referral information on Evernorth Health Services Home In-Home Primary Care services.

• Facilitate communication between external relationships and internal clinical/ops teams.

• Reports directly to Market Practice Manager.

• Conducts outreach to targeted physician offices to educate and guide the office on the program and delivery.

• Serves as primary contact for providers and provider staff to assist in contract management and provide supporting analyses for network and performance optimization.

• Develops and maintain positive relationships with providers and other cross-functional, cross-collaborative team including CMA, Operations, and Engagement, Coding, Finance, Marketing, Stars and providers, and will also support the Chronic Care Operations Department.

• Coverage Area: 45-mile radius from Houston city center.

• Requires up to 50-75% local travel to provider offices.

• Car and valid driver’s license required-mileage reimbursement provided.

• Responsible for creation and delivery materials to educate providers and provider staff on policies and procedures, contracting, quality, coding, service line initiatives and financial performance efficiencies.

• Maintain internal partnership with medical economics, legal, compliance, claims, health services, provider data management to operationalize contracting by meeting agreed parameters with legal counsel to lessen risk and improve operational.

• Organizes and conducts operating committee meetings with provider/groups to include policies and procedures, financial trends, quality ratings, coding performance, and other collaboration opportunities.

• Initiates and maintains effective channels of communication with providers, office staff and matrix partners.

• Assist in analysis of monthly cost trends for the direct market, including recommending solutions and assist in identifying action plans to remediate provider medical cost trends.

• Perform special projects and other duties assigned by 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.