Provider Contracting Director jobs in New Jersey
Provider Contracting Director is responsible for the operations of the provider contracts department. Ensures that provider contracts are processed to support accurate and efficient claims payments. Being a Provider Contracting Director oversees the formulation of provider contracts and specific terms. Analyzes contract data and provides financial projections. Additionally, Provider Contracting Director requires a bachelor's degree. Typically reports to top management. The Provider Contracting Director typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. To be a Provider Contracting Director typically requires 3+ years of managerial experience. (Copyright 2024 Salary.com)
Recently Added Provider Contracting Director jobs
Provider Contracting Senior Advisor - Hybrid
- The Cigna Group
-
Morris, NJ
FULL_TIME
-
This is a hybrid position which will require a weekly schedule of: 3 days working either in office or traveling to in-person meetings with Providers and 2 days working at home/remote.
Summary
National Contracting plays a significant role in The Cigna Group's Enterprise Affordability strategy. The LifeSOURCE Transplant Network managed by National Contracting is a key growth opportunity for Cigna and play a critical role in delivering affordability and network access for our Customers and Clients. LifeSOURCE consists of over 180 contracted facilities and represents roughly $1B in annual medical spend across US Commercial and US Government and growing. Heavy focus on controlling unit costs and trends in these contracts are critical for Cigna to achieve Affordability goals.
The Provider Contracting Senior Advisor is a key role in supporting the company's overall affordability programs, which directly address customer and client demands for lower cost and higher quality of care. This role will report to the Provider Contracting Director - LifeSOURCE and is accountable for the management of contracting and network management activities for the Northeast region.
Job Components And Deliverables
DRIVING AFFORDABILITY AND GROWTH- Responsible for meeting unit cost targets, while preserving an adequate network, to achieve and maintain LifeSOURCE’s competitive position
- Partners with Medical Economics to develop and present affordability opportunities using medical, claims data, financial, and other internal/external data
- Incorporates Industry/Competitive trends in programs/contracts
- Partners with local markets to drive network adequacy and membership growth/persistency strategies
- Partners with Payor Solutions operations to drive new revenue opportunities using the LifeSOURCE network across applicable lines of business
- Contributes to the development of alternative network initiatives. Supports and provides direction to develop network analytics required for the network solution.
- Demonstrates comprehensive knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape.
- Manages increasingly complex contracts and negotiations for transplant and advanced cellular therapy with sophisticated hospitals and physician groups for the assigned geographies.
- Proactively builds relationships that nurture provider partnerships to support the LifeSOURCE strategy
- Negotiates rates and terms on new and existing provider agreements
- Creates LifeSource agreements that meet internal operational standards and external provider expectations
- Identifies and targets new providers to bring in network
- Incorporates contract and compliance standards into provider agreements updates including use of a variety of reimbursement methodologies (fee-for-service, capitation, case rate, DRG, outcomes based adjusted, pay for performance, RBRVS)
- Responsible for contractual/financial performance of LifeSource provider agreements
- Mitigates risk associated with provider performance and termination
- Serves as single point of accountability for business relationship to Markets, Product, Clinical, Service Operations,
- Drives education and advocacy across markets and other internal matrix partners
- Contract language interpretation and document preparation to ensure accurate implementation and administration
- Bachelor’s Degree in Finance or related field highly preferred
- 5 years of Commercial Contracting and Negotiating experience involving complex delivery systems and organizations
- Strong understanding and experience with hospital, managed care, and provider business models
- Knowledge of transplant hospital contracting is preferred
- 25% regional travel required
- Detailed knowledge of Affordability initiatives and medical spend categories
- Superior problem solving, decision-making, negotiating skills, contract language and financial acumen
- Experience in developing and managing key provider relationships, including senior executives
- Team player with proven ability to develop strong working relationships within a fast-paced, matrix organization
- Knowledge and use of Microsoft Office tools
For this position, we anticipate offering an annual salary of 106,400 - 177,300 USD / yearly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group.
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. - 2 Days Ago
Director, Access & Contracting Management
- Lupin Pharmaceuticals
-
Somerset, NJ
CONTRACTOR
- Lupin is comprised of a fast growing, innovative and robust team of manufacturing, Research and Development and commercial divisions. Together these entities make up the generic and branded U.S. busin...
- Just Posted
Director, Government Contracting and Analytics
- Sanofi
-
Bridgewater, NJ
FULL_TIME
- JOB TITLE: Director, Government Contracting and AnalyticsLocation: Bridgewater, NJAbout The JobAre you ready to share the future of medicine? The race is on to speed up drug discovery and development ...
- 10 Days Ago
Associate Director, Contracting Strategy & Ops
- Amneal Pharmaceuticals
-
Bridgewater, NJ
FULL_TIME
- Job DescriptionJob SummaryThe Associate Director, Contracting Strategy & Operations will be responsible for contract management, oversight, business strategy, contract operations, account level operat...
- Just Posted
Associate Director, Contracting Strategy & Ops
- Amneal
-
Bridgewater, NJ
FULL_TIME
- Job Summary The Associate Director, Contracting Strategy & Operations will be responsible for contract management, oversight, business strategy, contract operations, account level operations managemen...
- 26 Days Ago
Contracting
- Formosa Plastics Corporation, U.S.A
-
Livingston, NJ
FULL_TIME
- Job Description : This petro-chemical industry Buyer position exists to perform the assigned Purchasing work to solicit the most competitive quotes in the most efficient and effective manner, reduce c...
- 20 Days Ago
Provider Contracting Director jobs at Popular Companies
Provisional Employee
- WK Kellogg Co
-
Omaha, NE
- At WK Kellogg Co, we exist to create joy and connection to inspire Gr-r-reat days. We believe that doing good is always ...
- 6/11/2024 12:00:00 AM
Personnel Clerk - Provisional
- Nassau BOCES
-
Garden City, NY
- Personnel Clerk - Provisional JobID: 1661 Position Type: Classified Staff/PERSONNEL CLERK Date Posted: 5/30/2024 Locatio...
- 6/11/2024 12:00:00 AM
Provisioner/ Logistics Specialist
- CACI International
-
Aberdeen Proving Ground, MD
- Provisioner/ Logistics Specialist Job Category: Logistics Time Type: Full time Minimum Clearance Required to Start: Secr...
- 6/11/2024 12:00:00 AM
RTE Provisioner SC
- E.A. Sween
-
Hodges, SC
- We are always looking for talented, hardworking people to join the E.A. Sween family. We are a third-generation family-o...
- 6/10/2024 12:00:00 AM
VoIP Provisioner
- Edge Communications
-
Plano, TX
- Job Description Job Description Title: VoIP Provisioner Reports to: Manager – Carrier Services Location: Plano Date: 05/...
- 6/9/2024 12:00:00 AM
Provisional Case Manager
- San Andreas Regional Center
-
Salinas, CA
- Job Summary: While maintaining good public relations and implementing the goals and vision of the regional center, this ...
- 6/8/2024 12:00:00 AM
Typist-Provisional MS
- Canandaigua City School District
-
Canandaigua, NY
- TYPIST-PROVISIONAL* Needed at the Middle School Full-time, 12-month position Starting as soon as possible Benefits provi...
- 6/7/2024 12:00:00 AM
Provisional Licensed Counselor
- Christian Wellness Center Of NJ LLC
-
Somerset, NJ
- Job Description Job Description Duties/Responsibilities: • Provide counseling for clients and patients, individually and...
- 6/7/2024 12:00:00 AM
About New Jersey
New Jersey is bordered on the north and northeast by New York (parts of which are across the Hudson River, Upper New York Bay, the Kill Van Kull, Newark Bay, and the Arthur Kill); on the east by the Atlantic Ocean; on the southwest by Delaware across Delaware Bay; and on the west by Pennsylvania across the Delaware River.
New Jersey is often broadly divided into three geographic regions: North Jersey, Central Jersey, and South Jersey. Some New Jersey residents do not consider Central Jersey a region in its own right, but others believe it is a separate geographic and cultural area from the Nor...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Contracting Director jobs
$189,945 to $274,333
Most Popular Cities in New Jersey for Provider Contracting Director Jobs
What does a Provider Contracting Director do?
Provider Contracting Director in New Suffolk, NY
The partners expect that their efforts toward greater collaboration between mutuelles and private providers will contribute to greater financial risk protection of covered citizens and support access to universal health coverage.
January 02, 2020
Provider Contracting Director in Vincennes, IN
The provider of services can choose how to perform the service.
January 27, 2020
Provider Contracting Director in Wichita Falls, TX
The Credentialing Committee is chaired by our Medical Director and they give the final determination if a provider meets our credentialing criteria.
December 05, 2019