Medicare Provider Performance Manager - Cigna Healthcare - Hybrid (Central Florida)
About the position
The Provider Performance Manager is a pivotal role within Cigna Healthcare, specifically designed to enhance the performance outcomes of the provider network in the Central Florida market, which includes Tampa, Orlando, and Jacksonville. This position is part of a collaborative cross-functional team that encompasses various departments such as Market Provider Performance, Sales, Health Services, Clinical, Stars & Risk Adjustment, Finance, Marketing, Cross-Segment Contracting, Provider Relations, and Network Development & Solutions. Reporting directly to the Provider Performance Director, the Manager is responsible for ensuring that the provider network meets its performance targets and adheres to compliance standards set by CMS and company policies. In this role, the Provider Performance Manager will develop and manage the talent of direct reports, leading network development initiatives and fostering key relationships with provider partners to drive optimal performance in areas such as Stars ratings, risk adjustment, utilization management, and overall financial performance. The Manager will also spearhead market-level projects and strategies aimed at enhancing provider engagement, preparing and facilitating external physician meetings, and conducting monthly financial reviews for senior management. This includes analyzing financials, quality metrics, coding progress, and action plans to ensure continuous improvement and accountability. The Provider Performance Manager is also tasked with the growth and profitability of the Medicare Advantage business in the assigned market. This involves ensuring exceptional service delivery, managing costs effectively, and developing the capabilities of team members. The role requires a strategic mindset, strong relationship-building skills, and the ability to lead cross-functional initiatives that enhance service delivery and improve overall business performance.
Responsibilities
Develop and manage talent of direct reports in the assigned Central Florida market.
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Lead network development within the Central Florida market and cultivate key provider partner relationships.
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Drive optimal performance on Stars, risk adjustment, utilization management, and overall financial performance.
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Lead market level projects and strategies related to provider engagement.
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Prepare for and facilitate external physician meetings and value-based contract administrative meetings (JOCs).
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Conduct monthly financial reviews to senior management, including financials, quality and coding progress, and action plans.
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Ensure compliance with CMS and company policies and guidelines.
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Lead cross-market, cross-functional initiatives and perform special projects as assigned.
Requirements
Bachelor's degree preferred.
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6-8 years of professional experience in a relevant field.
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People management experience strongly preferred.
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Ability to think strategically and apply business acumen to meet or exceed growth and profitability goals.
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Keen customer focus with the ability to develop strong relationships with providers.
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Capacity for leading initiatives and influencing cross-functional teams.
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Effective communication skills.
Nice-to-haves
Master's degree; MBA or other advanced degree preferred.
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Direct experience with health plan operations, preferably in government-sponsored health plans.
Benefits
Full-time position with competitive salary range of $118K - $150K.
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Opportunity to work in a hybrid environment.
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Access to a smoking cessation program.
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