Northeast Region Healthcare Provider Network Lead Analyst

The Cigna Group; Plano (TX); Remote; USD 69,000 - 116,000; Full time

Job summary

An established industry player is seeking a Network Operations Lead Analyst to join their dynamic team. This remote role involves leading regional projects, managing recruitment initiatives, and ensuring compliance with state guidelines. You will be pivotal in analyzing market trends and collaborating with various departments to enhance network operations. The ideal candidate will possess strong analytical skills, project management experience, and a solid background in healthcare. Join a company that values professional growth and offers a comprehensive benefits package focused on your well-being.

Benefits

Comprehensive Health Benefits

401(k) with Company Match

Tuition Reimbursement

Paid Time Off

Paid Holidays

Company Paid Life Insurance

Qualifications

• 5+ years of experience in Network Operations Contracting.
• Strong project management and analytical skills required.

Responsibilities

• Manage analyst training and recruitment projects.
• Lead market research and termination management meetings.

Skills

Network Operations Contracting

Healthcare Industry Experience

Project Management

Analytical Skills

Interpersonal Communication

Problem Solving

Education

Bachelor's Degree

Master's Degree

Tools

Microsoft Excel

Microsoft Access

Outlook

WebEx

PowerPoint

Job description

The job profile for this position is Network Operations Lead Analyst, which is a Band 3 Senior Contributor Career Track Role.

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LOCATION: REMOTE position aligned to the Northeast Region States in the USA

The Northeast Region Healthcare Provider Network Lead Analyst serves as an integral member of the Network Development and Competitive Insights Team within Network Operations and Provider Contracting and reports to the Northeast Regional Network Access Lead.

This role is responsible for leading regional product specific projects and/or components of larger national projects for the Northeast and Central regions. Responsible for managing the analyst team through review and coordination of all recruitment projects. Identifies proactive recruitment opportunities and manages the review and approval for all incoming recruitment projects. Responsibilities include the evaluation of project objectives/requirements, system requirements, the development of procedures/processes/policy solutions to address the complex business needs as well as adherence to state contracting and compliance guidelines. May direct one or more teams of business matrix partners to achieve project goals.

Manages the hospital/large group and/or significant provider termination management process in assigned markets for Commercial and IFP products. Works closely with Contracting, Network Solutions, Network Operations, Provider Services, Sales and Compliance to meet termination process management guidelines/state requirements.

Prepares competitive network benchmarking and industry comparative analysis to support Commercial and IFP products.

RESPONSIBILITIES:

• Manage new hire and existing analyst training as needed (technical skills and workflows). This includes the creation and maintenance of department workflows and related training documentation.

• Identify proactive recruitment projects and manage review and approval of all incoming recruitment projects. This relates to projects regarding: filling network adequacy gaps for all products, compliance filings and gap requirements, national account/middle market client specific requests, regional access builds, Essential Community Providers, TPV and/or Alliance partner conversion to direct networks or partner replacement. Includes managing the analyst team on project review/coordination with required matrix partners and reporting requirements to matrix partners and upper management regarding status.

• Work closely with Network Access Lead to support/provide required analysis work to map out required recruitment efforts/strategy to replace Third Party Vendors (TPV) in specific geographies and/or Alliance Partner replacements as required.

• Manage and track approved TPV conversions and/or Alliance Partner replacement projects in the Northeast and Central regions. This includes working directly with Market Deployment Managers and identifying project scope, managing specialty vendor recruitment/access in related geography, working directly with Contracting on market specific contracting activities to track completion and/or gaps to ensure network adequacy by required network cut over date. This also includes potential term management required support for hospitals/ancillaries that do not contract in time for network conversion date.

• Cover for Network Access Lead while on PTO and attend meetings for manager as needed.

• For assigned markets, review recruit project datasets to identify recruitment universe; Review potential recruits against Cigna systems to check for current/previous par status, approved specialty recruitment in specific geographies and validate if the provider is currently in recruitment under a separate initiative. Meet with the market Contracting/Provider Services teams to review and approve the final recruitment universe, appropriate fee schedule/contract paper and identify market contact to be aligned with the project.

• Manage the recruitment tracking tool: project data uploads and provider record maintenance for the duration of the project. Manage project reporting and distribution to matrix partners and senior management for assigned markets.

• Partner with Contracting and Sales/Service organizations to manage the review of providers identified as non-participating through the Regional Support Unit provide review process in support of pre-sale activities and current client non-par inquiries for assigned markets.

• Lead regional market research relating to competitor provider network participation status, competitor product development, regulatory developments and other market developments as appropriate for assigned markets.

• Lead Hospital/Large and/or Significant Provider Termination weekly workgroup meetings for assigned markets. Manage/Coordinate data reporting needs for all segments, including Commercial and IFP pending terminations within the region for assigned markets.

• Lead separate and/or additional termination management meetings as needed to discuss segment specific activities or non-standard termination tactics to support high visibility/challenging negotiations.

• Manage the creation and distribution of the weekly term management workgroup notes for assigned markets. Create and submit network change alerts for posting to Cigna’s internal tool, KnowledgeXchange, to communicate external notifications and changes for active potential hospital/large group or significant terminations. Coordinate Sales Effectiveness email process to all Sales opportunity owners with impacted clients. Manage all Sales requests for client specific data for impacted clients approved to receive PHI for required markets.

• Strive to become the subject matter expert (SME) for all assigned states and segments in your Region in support of all role activities; termination management, recruitment initiatives and competitive analysis.

• Work collaboratively with resources within the region, other regions and nationally to ensure projects are consistently managed, tracked and reported.

• Special projects as required.

QUALIFICATIONS:

• Bachelor’s degree, required; Master's degree, highly preferred

• 5+ years Network Operations Contracting experience, required

• 5+ years’ experience working in the Healthcare industry, required

• Cigna systems experience, required

• Proficient in the use of PC software; i.e., Outlook, WebEx, One Note, Power Point

• Strong Microsoft excel skills required

• Strong Microsoft Access skills a plus

• Working knowledge of hospital, managed care and provider business models

• Understanding of market specific nuances and network constructs

• Strong project management, analytical and critical thinking skills

• Superior problem solving and decision making skills

• Strong interpersonal and written/oral communication skills

• Proven ability to interact and negotiate effectively with various matrix partners

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.For this position, we anticipate offering an annual salary of 69,600 - 116,000 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.

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.