Perform regular network review to optimize cost and maximize value.
Lead the savings program to identify new opportunities for cost improvement in line with yearly target.
Collaborate with TPA to Build and manage the referral network.
Build new opportunities to secure discounts and rebates (network and customer based) in partnership with TPA.
Highlight strategic opportunities to Cigna Senior Management on new opportunities or expanding on existing opportunities with new or existing providers
Manage the reconciliation process with providers to ensure delivery in line with target.
Control risk cost, bend the claims curve and utilization/volume though regular utilization review.
Promote quality of healthcare by monitoring conversion/readmission rates, LOS, medical outcome, preventative healthcare.
Collaborate with TPA
Facilitate with TPA for the constructive handling or resolution of conflict with providers
Adherence to scope management and change control processes; assess and evaluate scope changes for feasibility and impacts on commitments
Experienced at identifying risks, issues, and mitigation plans and working with leadership to drive to resolution
Builds an environment of trust, collaboration, and openness among peers and other team members. Shares lessons learned, perceptions, and best practices openly with an eye towards continuous process improvement
Proposes recommendations and adjustments to project delivery and related solutions throughout the life of the initiative
Communicates clearly with all levels of stakeholders to ensure deliverables are hit. Can articulate tradeoffs and impacts with the big picture in mind to enable strategic and tactical decision making as well as mitigate risk.