Provider relations representative Jobs in Berkeley, CA

Medical Senior Director, Clinical Network and Provider Relations Cigna Healthcare

The Medical Senior Director, Clinical Network and Provider Relations will lead Cigna Healthcare's Clinical Network and Provider Collaboration strategy reporting directly to the Associate Chief Medical Officer (aCMO), Value-Based Care, Trend, and Network for Cigna Healthcare. This role is pivotal in strengthening Cigna's position as a trusted partner to the provider community by enhancing collaboration with frontline clinicians, provider leadership, and network contracting teams. This role will bolster and elevate Cigna's reputation as a trusted partner to providers nationwide through a multi-pronged strategy supported by a dedicated team, enhanced reporting, novel product and partnership offerings, and re-imagined communication channels. The leader will build and oversee a focused physician and nurse-staffed clinical team, elevate relationship management discipline and strategy, re-envision data sharing and performance support capabilities, and lead the transition to a proactive approach to provider relations.

The successful candidate for this role will be a physician leader with provider, network and value-based care experience and will have managed internal provider teams as well as liaised closely with external provider leadership and networks. This role requires a growth-oriented, motivational, and collaborative leader capable of building strong relationships and partnerships within their team and at all levels of the organization, across matrix partnerships (primarily within the network and provider relations teams, but also beyond) and with senior-most enterprise leadership.

Key Responsibilities :

• Provider Network Management : Establish and lead a regionally oriented, recognized as best-in-class team of dedicated Medical Executives and Nurse Clinical Executives to enhance Cigna's presence and impact in the market and internally with providers and internal network partners.
• Provider Relations : Partner with the matrix partner provider relations and network operations teams to optimize our communication, educational efforts, and performance enablement with providers.
• Enable Value-Based Care Strategy : Collaborate with CHC's Clinical VBC leadership to support the translation of strategy into accountable care contracts with providers, with a focus on deepening provider partnerships, enhancing communication, and enabling providers' success and retention in value-based care.
• Clinical & Financial Integration and Action : Partner with CHC's financial and trend teams to align local clinical programs to better drive financial performance metrics within each market and to leverage data to enable exceptional clinical outcomes, successful TCOC improvement efforts, and continuous provider engagement.
• Team Leadership & Development : Build and harness the potential of a high-performing team, including medical executives, nurse executives, and project management.
• Operational Execution : Implement scalable processes to elevate Cigna's provider relationships and reputation within the provider community, including enhanced tracking of relationship and performance outcomes, optimized governance, enhanced communication and education channels, and revised provider advisory bodies.

Qualifications & Experience :

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.

This role is also anticipated to be eligible to participate in an annual bonus and long term incentive plan.

This role is also anticipated to be eligible to participate in an annual bonus and long term incentive plan.