Contract Manager, Hospital & Physician Negotiations Job at The Cigna Group (Pittsburgh)

Vice President of Payer Contracting

The Vice President of Payer Contracting provides strategic and operational leade...

Location

United States , South Burlington

Salary:

320838.00 - 481258.00 USD / Year

The University of Vermont Health Network

Expiration Date

Until further notice

Requirements

Bachelor's degree in business, Healthcare Administration, Finance, or related field required
Master’s degree (MBA, MHA, MPH, or equivalent) is strongly preferred
Juris Doctor (JD) is required
10+ years of progressive experience in managed care contracting within a health system, integrated delivery network (IDN), or payer organization
Proven success in developing and negotiating value-based and risk-sharing contracts
Strong understanding of payer reimbursement methodologies, population health models, and alternative payment programs (e.g., ACOs, bundled payments, shared savings)
Experience conducting significant managed care payer negotiations
Analytic-minded leader with depth of experience in contract modeling and assessing financial implications of new contracting structures
Possess understanding of emerging trends in value-based contracting and payment innovation, such as physician compensation redesign, patient centered medical homes, bundled payments, and commercial, federal and state ACO programs

Job Responsibility

Provides strategic and operational leadership for all payer contracting initiatives across the health system
Developing, negotiating, and managing commercial and government payer agreements that align with the organization’s high value care strategy, operations, and advances the organization’s commitment to value-based care, quality outcomes, and financial sustainability
Shaping payer partnerships that reward high-quality, efficient care delivery and support the system’s transformation toward risk-based and population health models
Leading contracting for hospitals, physician enterprise and post-acute facilities within the health system

What we offer

Relocation support is available to a final candidate who does not already live in the region served by UVM Health

Fulltime

Manager, Network Management

Join Cigna Healthcare, a division of The Cigna Group, and help shape our provide...

Location

United States of America , Richmond, Virginia

Salary:

92000.00 - 153300.00 USD / Year

The Cigna Group

Expiration Date

Until further notice

Requirements

3+ years of healthcare provider contracting and negotiation experience involving complex physician groups and ancillary providers
Experience in managed care, healthcare, or health insurance, including commercial contracting
Proven leadership experience, including mentoring and guiding others
Strong provider relationship management skills, with demonstrated success building long‑term partnerships
Knowledge of complex reimbursement methodologies, including incentive‑based models (strongly preferred)
Deep understanding of hospital, managed care, and provider business models, with the ability to influence sales and provider audiences
Strong presentation and communication skills, including the ability to build internal relationships in a fast‑paced, matrixed organization
Customer‑centric approach with strong interpersonal skills and comfort navigating change
Strong problem‑solving, decision‑making, negotiation, contract interpretation, and financial analysis skills
Proficiency in Microsoft Office

Job Responsibility

Manage complex fee‑for‑service and value‑based contracting and negotiations with large physician groups, ancillary providers, and hospital systems
Lead key market contracting strategy projects, with responsibility for managing direct reports as assigned
Build and maintain strong provider relationships to support network growth and value‑based business opportunities
Partner closely with matrix teams (e.g., Claims, Medical Management, Credentialing) to ensure aligned execution
Develop strategic network positions, identify value‑oriented and risk‑based opportunities, and contribute to alternative network initiatives and analytics
Meet unit cost targets while maintaining an adequate and competitive provider network
Design and manage initiatives to improve medical cost and quality, providing consultative guidance informed by clinical informatics
Prepare, review, and project the financial impact of large or complex provider contracts and alternative contract terms
Create, implement, and ensure operational accuracy of healthcare provider (HCP) agreements through effective cross‑functional collaboration
Lead the resolution of escalated provider issues and manage key provider relationships, demonstrating deep knowledge of the local market landscape, including contract loading and maintenance

What we offer

Annual bonus plan eligibility
Medical, vision, dental, and well-being and behavioral health programs
401(k)
Company paid life insurance
Tuition reimbursement
Minimum of 18 days of paid time off per year
Paid holidays

Fulltime

Lead Director, Network Management

We're building a world of health around every individual — shaping a more connec...

Location

United States , Work at Home

Salary:

100000.00 - 231540.00 USD / Year

CVS Health

Expiration Date

June 27, 2026

Requirements

A minimum of 10 years related experience and expert level negotiation skills with successful track record negotiating contracts with large or complex provider systems
Demonstrated experience in Medicaid provider contracting, including negotiating, executing, and managing agreements with hospitals, physician groups, and ancillary providers
Hands-on experience with Behavioral Health (BH) network development and contracting, including providers across inpatient, outpatient, and community-based settings
Proven ability to manage the end-to-end contracting lifecycle (negotiation, redlining, implementation, and ongoing relationship management)
Strong knowledge of Medicaid regulations, state requirements, and network adequacy standards, with the ability to ensure compliance across market
Experience developing or supporting value-based arrangements and reimbursement models within Medicaid and Behavioral Health populations
Demonstrated ability to build, manage, and grow strategic relationships that advance long-term organizational goals
Experience presenting complex information to groups in a clear, concise, and persuasive manner, adapting style and content to audience needs

Job Responsibility

Developing strategic partnerships for the Kentucky Medicaid Health Plan
Designing conceptual models, initiative planning, and negotiating high value contracts with the most complex and challenging hospital systems, integrated delivery systems and large groups
Maintaining and enhancing provider networks
Building strong relationships with providers
Developing and executing contract strategies
Negotiating and managing various value based payment models and management of contract performance
Recruiting providers as needed to ensure attainment of network expansion and adequacy targets
Identifying and managing cost issues
Collaborating cross functionally to execute significant cost saving initiatives
Promoting collaboration with internal partners

What we offer

Medical, dental, and vision coverage
Paid time off
Retirement savings options
Wellness programs
Bonus, commission or short-term incentive program
Equity award program

Fulltime

Certified Epic Analyst

Baptist Health is hiring a Certified Epic Analyst to join our team. This is a fu...

Location

United States , Tallahassee

Salary:

Not provided

Baptist Health (Florida)

Expiration Date

Until further notice

Requirements

Managed Care Contract
Bachelor of Science (non Nursing) Required
EPIC Resolute Hospital Billing Expected Reimbursement Contracts Administration Certified
EPIC Resolute Physician Billing Expected Reimbursement Contracts Administration Certified

Job Responsibility

Accurately load managed care contracts, government contracts and special contracts for Baptist Health hospitals, physicians, and ancillary entities into the Epic system
Test the reimbursement functions and collaborate with managed care plans to ensure timely and accurate contract loads by the managed care plans
Complete necessary steps to operationalize contracts following completion of negotiations

Fulltime

Manager, Network Management

The Contract Manager, Physician & Ancillary Negotiations serves as an integral m...

Location

United States of America , Richmond

Salary:

Not provided

The Cigna Group

Expiration Date

Until further notice

Requirements

3+ years Healthcare Provider Contracting and Negotiating experience involving complex Physician Groups and Ancillaries required
Experience in a Managed Care, Healthcare or Health Insurance environment
Experience with Commercial Healthcare contracting
Significant experience leading and mentoring others
Experience in developing and managing key provider relationships
Knowledge of complex reimbursement methodologies, including incentive based models strongly preferred
Demonstrated experience in seeking out, building and nurturing strong external relationships with provider partners
Intimate understanding and experience with hospital, managed care, and provider business models
Team player with proven ability to develop strong working relationships within a fast-paced, matrix organization
The ability to influence both sales and provider audiences through strong written and verbal communication skills

Job Responsibility

Manages complex contracting and negotiations for fee for service and value-based reimbursements with large Physician groups, Ancillaries and Hospital systems
May lead a team with direct reports
Point person for complex projects related to contracting strategy in the market
Builds relationships that nurture provider partnerships and seeks broader value-based business opportunities to support the local market strategy
Initiates and maintains effective channels of communication with matrix partners including but not limited to, Claims Operations, Medical Management. Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing and Service
Manages strategic positioning for provider contracting, develops networks and identifies opportunities for greater value-orientation and risk arrangements
Contributes to the development of alternative network initiatives
Supports and provides direction to develop network analytics required for the network solution
Works to meet unit cost targets, while preserving an adequate network, to achieve and maintain Cigna's competitive position
Creates and manages initiatives that improve total medical cost and quality

Managed Care Senior Manager

Corporate level manager responsible for deploying and contributing to strategic ...

Location

United States , Fort Lauderdale

Salary:

Not provided

Memorial Healthcare System

Expiration Date

Until further notice

Requirements

Bachelors
Five (5) years contracting experience with three (3) years contracting for hospital, professional services, ancillary facilities or specialty networks

Job Responsibility

Execute, contribute and manage complex legal, financial and operational contract language negotiations in concert with the Director of Managed Care or independently as applicable to the negotiation
Execute contracting strategies for all service lines in Memorial Hospitals, MHS employed physicians, transplant programs, and ancillary services of the fully integrated healthcare delivery system and its joint owned or joint ventured entities for fee for service and value based arrangements
Direct and analyze financial performance, reports and models, quality metrics and cost savings for negotiations with national and regional payors
Plan and monitor activities of staff and team members including hiring, orienting, training, mentoring, continuing education, evaluating, coaching and disciplinary actions
Enhance, estimate and preserve net revenues
Assure financial viability of contracts through financial analysis and forecasting in conjunction with Financial Analyst(s), contract negotiations and issue resolution
Execute strategies and guides operations to protect and build market share
Interface with managed care plans on claim reconciliations, trended issues and operational projects
Determine root cause and seek resolution
Evaluate payor assessments of overpayments and effectively dispute or resolve for settlement

Fulltime

Healthcare Regulatory Lawyer

We are currently seeking Healthcare Regulatory and Operations Lawyers to work wi...

Location

United States

Salary:

150000.00 USD / Year

Axiom Law

Expiration Date

Until further notice

Requirements

5+ years of experience in healthcare or life sciences industries or private practice supporting clients in the healthcare or life science industries
Healthcare plan experience strongly preferred
Able to negotiate and draft complex contracts and related documents
Transactional healthcare experience handling hospital, health system or physician practice acquisitions, physician contracts, joint ventures, and affiliations
Experience conducting internal corporate investigations of potential violations of legal/regulatory requirements and of corporate requirements/expectations
Familiarity with U.S. privacy law, HIPAA, Anti-Kickback Statute, Stark Law and FDA compliance is required
The ability to thrive in a large, fast-paced environment with a high level of professionalism and outstanding business judgment
Active bar membership in the state in which you intend to practice

Job Responsibility

Manage and ensure compliance with HIPAA, Medicare, Medicaid, and Medi-Cal programs
Oversee licensing and accreditation processes within healthcare operations
Safeguard patient privacy and ensure adherence to informed consent laws
Optimize revenue cycle management and reimbursement strategies
Support physician management by focusing on compliance and regulatory issues

What we offer

health benefits
401K
professional development resources
learning and development programs

Director - Managed Care

Corporate-level leader responsible for executing enterprise-wide strategic and t...

Location

United States , Hollywood

Salary:

Not provided

Memorial Healthcare System

Expiration Date

Until further notice

Requirements

Bachelors (Required)
7 years managed care contracting experience with emphasis on facility contracting, preferably with local market knowledge
Payer and provider experience preferred
Requires critical thinking skills, effective communication skills, decisive judgment and the ability to work with minimal supervision
Must be able to work in a stressful environment and take appropriate action
Strong technical, financial and negotiation skills
Extensive managed care insurance and hospital industry knowledge

Job Responsibility

Enhance, estimate and preserve net revenues
Assures financial viability of contracts through financial analysis and forecasting in conjunction with Financial Analyst(s), contract negotiations and issue resolution
Execute strategies and guides operations to protect and build market share
Plan and monitor activities of staff and/or team members including hiring, orienting, training, mentoring, continuing education, evaluating, coaching & disciplinary actions, as applicable
Execute and manage complex legal, financial and operational contract language negotiations
Execute contracting strategy for all service lines in Memorial hospitals, Atlantic Coast Health Network (clinically integrated network), Memorial Health Network (clinically integrated network), MHS employed physicians, transplant programs (including subcontracting hospital-based groups), and ancillary services (ambulatory surgical centers, skilled nursing facility, rehabilitation facility, home health, home infusion, urgent care centers, sleep labs and other components) of the fully integrated healthcare delivery system, and its jointly-owned or joint-ventured entities for fee-for-service and value based agreements (capitation, bundled payments, pay for performance, shared savings, shared risk and full risk agreements)
Direct and analyze financial performance, reports and models, quality metrics and cost savings for negotiations with major national and regional payors
Monitor department operations, activities, resources to meet budget and goals
Respond to insurance industry activities, healthcare reform, payer strategies, emerging market demands, and legislative considerations and changes to the managed care industry to maintain a competitive position
Initiate and research new business opportunities (relationships, pricing, services, structures, operations, quality)

Fulltime

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Contract Manager, Hospital & Physician Negotiations

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