Back to Jobs

Hospital Provider Contract Negotiator, Healthcare - Houston, TX market - Cigna

Remote, USA Full-time Posted 2025-04-16

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 possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply!

Our people make all the difference in our success.

LOCATION: Preference for candidate to live in Houston, TX

Will consider candidates that live in San Antonio or Austin, TX

This position will support Provider Contracting for our Commercial Employer business. Must have experience in Healthcare Contracting and Negotiations with large Hospital, Health systems and Physician Groups. Must have experience working with Commercial/Employer Healthcare Contracting.

Manager, Provider Contract Network Management position 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 ?CP?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 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 Healthcare Provider Contracting and Negotiating experience involving complex Hospital/Health systems/Physician groups/Ancillary delivery systems and organizations required.
?Experience in developing and managing key provider relationships
?Knowledge of complex reimbursement methodologies, including Value Base 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.
?Demonstrated experience with analytics tools and involving review of claims/historical data to identify rate reimbursements.
?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.
?Knowledge and use of Microsoft Office tools.

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.

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.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Apply Job!

 

Similar Jobs

Data Science Sr Lead Analyst (SVP) - Fair Lending Mortgage Analysis

Remote, USA Full-time

Sr Manager, Software Development & Engineering (PL) - Client Data Technology

Remote, USA Full-time

Data Analyst - Early Career at Lockheed Martin Fort Worth, TX

Remote, USA Full-time

Sr. Systems Engineer - Mission Management, Space Intelligence, Surveillance, & Reconnaissance

Remote, USA Full-time

Lead Software Engineer - Full Stack (Multiple openings) in Irving, TX

Remote, USA Full-time

Engineer/Sr Engineer, IT Radio Communications Job at American Airlines in Dallas

Remote, USA Full-time

Senior Software Engineer, Back End (Java, Python, AWS)- Navigator Platform Tech

Remote, USA Full-time

Retail Cosmetics Sales Associate - Clinique, Memorial City - Part Time

Remote, USA Full-time

Geographic Information Systems (GIS)/Data Analyst - Land Use and Mobility Options

Remote, USA Full-time

Retail Support Associate - Ready to Wear, Castleton - Full Time

Remote, USA Full-time

Apple Support College Program At Home Advisor

Remote, USA Full-time

Southwest Airlines Analyst Job $25Hr - VacancyGlobal

Remote, USA Full-time

Flexible Work ?? Part Time Sales ?? Work from Home | Fairfield

Remote, USA Full-time

Amazon jobs at home - Office Associate (work at home)

Remote, USA Full-time

Urgently Need Remote English Tutor ?? Part Time in Papillion, NE

Remote, USA Full-time

Delivery Driver

Remote, USA Full-time

Prompt Engineer

Remote, USA Full-time

Remote Opportunities with American Airlines

Remote, USA Full-time

Remote/West Coast-Digital Direct Agent

Remote, USA Full-time

Verizon Remote Customer Service - Apply Now

Remote, USA Full-time