Provider Contracting Manager jobs in North Carolina

Provider Contracting Manager manages the activities of the contracting staff that prepare and maintain contracts and the contracts database system for a health plan network. Responsible for negotiating with facilities joining the health network and setting rates. Being a Provider Contracting Manager oversees network reporting requirements to ensure compliance with regulatory agencies, and to produce accurate and relevant reporting of data. Trains and develops staff. Additionally, Provider Contracting Manager requires a bachelor's degree. Typically reports to a head of a unit/department. The Provider Contracting Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Extensive knowledge of department processes. To be a Provider Contracting Manager typically requires 5 years experience in the related area as an individual contributor. 1 to 3 years supervisory experience may be required. (Copyright 2024 Salary.com)

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Manager, Provider Contracting - North Carolina market - Hybrid
  • The Cigna Group
  • Charlotte, NC FULL_TIME
  • LOCATION: Based in Raleigh or Charlotte, NC office

    Medicare Advantage position

    The Manager, Provider Network Contracting serves as an integral member of the Provider Contracting Team and reports to the Provider Contracting Senior Manager. This role assists in developing the strategic direction and management of the day to day contracting and network management activities for a local given territory.

    DUTIES AND RESPONSIBILITIES

    • Manages complex contracting and negotiations for fee for service and value-based reimbursements with hospitals and other providers (e.g., Hospital systems, Ancillaries, and large physician groups).

    • Builds relationships that nurture provider partnerships and seeks broader value-based business opportunities to support the local market strategy.

    • Initiates and maintains effective channels of communication with matrix partners including but not limited to, 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. Supports and provides direction to develop network analytics required for the network solution.

    • Works to meet unit cost targets, while preserving an adequate network, to achieve and 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 to assist with total medical cost initiatives.

    • Prepares, analyzes, reviews, and projects financial impact of larger or complex provider contracts and alternate contract terms.

    • Creates “HCP” agreements that meet internal operational standards and external provider expectations. Ensures the accurate implementation, and administration through matrix partners.

    • Assists in resolving elevated and complex provider service complaints. Researches problems and negotiates with internal/external partners/customers to resolve highly complex and/or escalated issues.

    • Manages key provider relationships and is accountable for critical interface with providers and business staff.

    • Demonstrates knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape.

    • Responsible for accurate and timely contract loading and submissions and interface with matrix partners for network implementation and maintenance.

    • May provide guidance or expertise to less experienced specialists.

    POSITION REQUIREMENTS

    • Should possess a Bachelor's Degree; preferably in the areas of Finance, Economics, Healthcare or Business related. Significant industry experience will be considered in lieu of a Bachelor degree. MBA or MHA preferred

    • 3 years of Healthcare Provider Contracting and Negotiating experience involving complex delivery systems and organizations required.

    • Experience in developing and managing key provider relationships

    • Knowledge of complex reimbursement methodologies, including incentive based models strongly preferred

    • Demonstrated experience in seeking out, building and nurturing strong external relationships with provider partners

    • Intimate understanding and experience with hospital, managed care, and provider business models

    • Team player with proven ability to develop strong working relationships within a fast-paced, matrix organization

    • The ability to influence both sales and provider audiences through strong written and verbal communication skills. Experience with formal presentations.

    • Customer centric and interpersonal skills are required.

    • Demonstrates managerial courage as well as an ability to maneuver effectively in a changing environment.

    • Superior problem solving, decision-making, negotiating skills, contract language and financial acumen.

    • Proficient with Microsoft Office (Word, Excel, PowerPoint, Outlook)

    • Requires ability for local travel to Network Providers


    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.

  • 19 Days Ago

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Manager, Provider Contracting - North Carolina market - Hybrid
  • The Cigna Group
  • Raleigh, NC OTHER,FULL_TIME
  • The job profile for this position is Provider Contracting Advisor, which is a Band 4 Senior Contributor Career Track Role.Excited to grow your career?We value our talented employees, and whenever poss...
  • 24 Days Ago

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Manager - Managed Care Contracting
  • Candidate Experience site
  • Charlotte, NC FULL_TIME
  • Job Summary Responsible for managed care portfolio performance for assigned payors. Work with Management on implementation of contracting strategy for the System. Independently negotiate contract lang...
  • 1 Month Ago

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Provider Contracting Senior Analyst - Italian Speaker
  • The Cigna Group
  • Charlotte, NC FULL_TIME
  • CGHB Provider Network Manager. will be responsible for developing and executing negotiation strategies working directly with contracted providers in order to deliver best in class service to CGHB’s pr...
  • 4 Days Ago

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Construction Project Manager
  • Carolina's Contracting
  • Charlotte, NC FULL_TIME
  • Manage team Able to Multitask Attention to detail Compile and plan budgets, cost estimates Coordinate schedules Description listed
  • 10 Days Ago

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Senior Contracting Operations Project Manager
  • Brady Services
  • Morrisville, NC OTHER
  • Job Details Job Location: Raleigh Office - Morrisville, NC Position Type: Full Time Education Level: 2 Year Degree Salary Range: Undisclosed DescriptionAre you a Sr. Project Manager looking for a grea...
  • 15 Days Ago

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Contract Manager - Contracts & Technology Legal
  • The Travelers Indemnity Company
  • New York, NY
  • Who Are We? Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this...
  • 3/28/2024 12:00:00 AM

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Contracts Manager / Senior Contracts Manager
  • Cymabay Therapeutics
  • Newark, CA
  • We are searching for a Contracts Manager / Senior Contracts Manager to join our legal department. The candidate will nee...
  • 3/27/2024 12:00:00 AM

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Provider Contracts Manager
  • Molina Healthcare
  • Rochester, NY
  • ***Remote and must live in New York*** Job Description Job Summary Molina Health Plan Provider Network Contracting jobs ...
  • 3/25/2024 12:00:00 AM

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Contract Manager
  • CyrusOne
  • The Contract Manager will assist in the management of all third party or outsourced vendors with a specific concentratio...
  • 3/25/2024 12:00:00 AM

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Contract Manager
  • Accede Solutions, Inc.
  • Carbondale, IL
  • Duration: 1 year Mon - Thu Responsibilities: Negotiate contracts with vendors, suppliers, and service providers to ensur...
  • 3/25/2024 12:00:00 AM

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Provider Contracting Manager | Bay Area
  • Selby Jennings
  • Overview Our client, a large health insurance agency, is seeking a skilled Provider Contracting Manager to oversee the n...
  • 3/24/2024 12:00:00 AM

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Contract Manager
  • VieMed
  • Lafayette, LA
  • Essential Duties and Responsibilities Maintain catalog of approved vendors for VieMed. Ensure all stages of the vendor o...
  • 3/24/2024 12:00:00 AM

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Contract Manager
  • MbSolutions, Inc.
  • Fort Belvoir, VA
  • Contract Manager: Education: Minimum of a bachelor's degree. Qualifications: Minimum of eight years of Army Force Manage...
  • 3/24/2024 12:00:00 AM

North Carolina (/ˌkærəˈlaɪnə/ (listen)) is a state in the southeastern region of the United States. It borders South Carolina and Georgia to the south, Tennessee to the west, Virginia to the north, and the Atlantic Ocean to the east. North Carolina is the 28th-most extensive and the 9th-most populous of the U.S. states. The state is divided into 100 counties. The capital is Raleigh, which along with Durham and Chapel Hill is home to the largest research park in the United States (Research Triangle Park). The most populous municipality is Charlotte, which is the second-largest banking center in...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Contracting Manager jobs
$104,580 to $138,881

Provider Contracting Manager in Gastonia, NC
By simplifying and automating the provider contracting lifecycle, we help make it easier for health plans to identify and implement savings opportunities to obtain maximum value from provider relationships.
January 09, 2020
Provider Contracting Manager in Springfield, IL
Responsible for the oversight of their assigned networks to ensure network provider deficiencies are being met and working closely with their assigned Network Support staff and Medical Management counterparts to ensure network needs/changes are being effectively addressed and communicated both internally and externally.
January 19, 2020
Provider Contracting Manager in Cedar Rapids, IA
New care delivery models, complex regulations and narrowing provider networks have significantly altered the provider contract management process.
February 03, 2020