Cigna Medicaid Operations Director in Bedford, Texas

Description:

SUMMARY:

This position is accountable for the operating results, strategic direction, and growth of network operations, civic / government affairs, and communication and relationship with States, including oversight of the contractual compliance and RFP process for new Medicaid opportunities.Additionally, this position oversees Customer Service, including Service Operations and Appeals and Grievances.This role establishes specific direction and goals in support of and alignment with overall strategies and objectives to ensure integration and coordination among all functions including, but not limited to, network development and network adequacy, contracts, contract development, credentialing, and /or provider services. Typically requires ten years related experience and seven or more years management experience. Position reports to Cigna HealthSpring General Manager and has functional managers and project managers as direct reports.

RESPONSIBILITIES:

·Responsible for the operational management of the provider network, which may include network development, contracting, network adequacy, credentialing, provider relations, provider services, and operations. Responsible for providing policy administration for provider networks and ensuring contractual compliance with governmental regulations and contracts.

·Interfaces and builds relationships with leaders in the medical and government community.Negotiates, evaluates and develops network development opportunities. Participates in cross-department teams to analyze business opportunities and address critical issues (e.g. network growth, provider termination, etc.)Collaborates with local Cigna leadership on network development, network financial, quality and physician performance and engagement opportunities.

·Ensures a strong “customer centricity” focus throughout Medicaid Operations, with a monitoring component to provide feedback for GM review and for staff.Further, ensures processes are in place to respond to customer complaints and resolve problems leading to the complaints.

·Develops and maintains strong constructive relationships with state and federal partners.Ensures physician engagement and excellent state relationships; defines a culture of collaboration and accountability; successful execution of all attraction, development, motivation and retention efforts. Serves as the face of Cigna-HealthSpring Medicaid within the market to these external constituents.

·Evaluates the current human capital in the areas of responsibility; ensures the right person is in the right role, provides developmental plans and appropriate mentorship, and where appropriate, makes effective decisions which will strengthen the team and overall organization.

·Ensures the business unit collaborates with the compliance and legal department to drive prudent and sustainable growth. Additionally, ensures the business units collaborate with all shared service matrix partners to achieve financial and operational performance goals.

·Positions C-HS Medicaid to adjust to healthcare reform changes associated with quality, customer service, market pressures, and policies.

·Assures consistency of operations, compliance with all applicable laws, rules and standards of all regulatory bodies and accreditation agencies.

·Drives revenue or unit cost management; successful implementation of partnership for quality or institutional initiatives; development of networks including expansion markets; overall performance of physician networks, and strategic planning.

  • Effectively creates, manages and maximizes key relationships to create synergies, alliances and new opportunities.
  • Develops, implements and manages the adoption of controls that allow the organization to quickly identify trends and potential issues and address them in a timely manner.

  • Drives improvement in market Provider and Member satisfaction results by leading and developing a customer centric culture.Develops customer focused training, polices, best practices in the Service Operations divisions.

  • Creates a cohesive, efficient, action oriented physician support model that drives cost mitigation and efficient use of resources, along with continuous quality and service improvement, both in-market and supported broadly by Cigna.

Qualifications:

Qualifications

  • Strong Medicaid Managed Care knowledge and a minimum of 10 years of related experience.
  • Knowledge of Texas Medicaid programs, procedures, reporting and regulatory requirements.
  • Bachelor’s Degree required; MBA or Master’s Degree in HealthCare Administration or health-related field preferred.
  • Experience in provider contracting and network development involving complex hospital systems, integrated delivery systems and large physician groups (IPAs and PPMs), etc., including risk arrangements.
  • 5 years people management experience preferred.
  • Excellent knowledge of physician engagement and experience building trust with physicians.
  • Strong knowledge of managed care (e.g., network design, products, customer service, provider communities, etc.), regulatory environment, and compliance issues (e.g., NCQA accreditation issues, credentialing, delegation and oversight standards, etc.).
  • Excellent interpersonal and relationship management skills.
  • Excellent oral, written and presentation skills.
  • Proven ability to function in a heavily matrixed environment.
  • Proven ability to foster collaboration, value others perspectives and gain support and buy-in for organizational proposals.
  • Strong organizational and analytical skills that result in conclusive recommendations.
  • Ability to establish community-based partnerships with providers and other stakeholders.

US Candidates Only : Qualified applicants will be considered for employment without regard to race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status. If you require a special accommodation, please visit our Careers website or contact us atSeeYourself@cigna.com.

Primary Location: Bedford-Texas

Work Locations: 2208 North Highway 121 STE 210 Bedford 76021

Job: Bus Ops--Operations Mgmt (Bus)

Schedule: Regular

Shift: Standard

Employee Status: Manager of Managers

Job Type: Full-time

Job Level: Day Job

Travel: Yes, 25 % of the Time

Job Posting: Apr 19, 2017, 3:35:27 PM