Head of Network Emea
il y a 7 heures
The Head of Network - EMEA position serves as an integral member of the Global Delivery Systems. This role is responsible for developing and executing contract negotiation and provider collaboration strategies, and working directly with providers in the Americas continent region (including US Territories, Caribbean, Guam) in order to deliver best in class network to Cigna’s customers and act as the Subject Matter Expert regarding the regional/local market’s environment, healthcare delivery practices and pricing. This role will also represent the network interest of Cigna’s Americas P&L Market (AM) in driving network progress to support AM’s growth tracks by working with cross-regional Network teams and direct providers, CignaLinks and other third-party administrator capabilities. This position reports to the SVP of Global Delivery Systems.
**Duties and responsibilities**:
Leads network functions including strategy, contract negotiations, network expansions, delivery systems capabilities, provider onboarding processes, and provider relations.
Drives strategic progression and implementation in CignaLink’s increasing value, deliverables and ROIs.
Accountable for driving network affordability agenda and targets in the Americas network region for global markets, as well as articulating (and if applicable mitigation plans) results and drivers relating to AM’s P&L network savings.
Develops progressive network capabilities in improving provider collaboration, access to care, alternative channels to care, and other network/process capability in improving affordability, simplicity and predictably of care.
Performs service area analysis and cost analysis to identify network gaps, network expansion or development areas, and contract renegotiation opportunities.
Proactively builds relationships that nurture provider partnerships and seeks broader value-based business opportunities to support the local/regional market strategies.
Manages and mentors a team of Negotiators and Provider Relations ensuring that the access to care and affordability targets are met.
Identifies and articulates Americas local norms of how delivery systems work with payers (billing, processes, etc.) and assist with plans to improve current provider and member experience.
Initiates, nurtures and maintains effective channels and processes of communication with matrix partners including but not limited to, Claim Operations, Medical Management, Legal, Medical Economics, Compliance, Client Management, Sales and Marketing and if applicable vendor services.
Promotes process improvement initiatives by identifying and successfully positioning service improvement opportunities and strategies within the Americas Network Management department, other CIGNA departments and alliance partner organizations.
Assists in resolving elevated and complex provider service complaints. Researches problems and negotiates with internal/externa partners/customers to resolve highly complex and/or escalated issues
Identifies cost containment opportunities and (re)negotiate favorable conditions with Health care providers. Including but not limited to payment integrity improvement opportunities and FWA activities in the region.
Manages the relationship with existing and new and Third Party Vendors.
Monitors the quality of the services provided by the medical providers and the correct execution of the agreements.
Reviews (and/or draft and edit) Network RFP responses and at times presents at the client or finalist meetings with AM commercial teams.
Collaborates with Medical Economics team to articulate business assumptions and contract savings forecast in estimating affordability initiatives impact.
Acts as the expert for the providers with regards to the agreements, fees and pricing in the region for which you are responsible.
Acts as an expert with regards to the medical landscape in the countries within your region and continuously monitor evolutions in that respect. Key Challenges / Anticipated Changes in Environment.
Effectively communicates and interacts with other business units to achieve goals; e.g. Medical Management, CIGNA Service Operations (NA, UK and Antwerp), Sales and Client Management (NA, UK, and Antwerp), and CIGNA Strategy & Operations.
**Qualifications**:
Must be able to work from US, at least for the initial 6-8 months in post.
Should possess a bachelor degree; preferably in the areas of Healthcare Finance, Economics, and healthcare administration. Significant industry experience will be considered in lieu of a Bachelor degree. MBA or MHA preferred.
5+ years of contracting and negotiating experience in the international involving complex delivery systems and TPAs required.
Must have deep understanding and experience (and relationship) of local providers, health systems, and key players in the Americas regional market.
Demonstrated experience in seeking out, building and nurturing strong external relationships with provider partners.
Knowledge of
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