Provider Relations Program Manager

5 days ago

Montréal, Canada The Cigna Group Full time

Express Scripts Canada’s (ESC’s) Provider Relations Department is responsible for managing provider contracts, the registration of health care providers from across Canada, the maintenance of ESC’s provider network as well as communications with providers and provider associations. Providers submit electronic and paper claims to ESC on behalf of their patients which are plan members of ESC’s insurance and Third-Party Administration customers.

Express Scripts Canada is looking for a self-motivated and energetic Provider Relations Program Manager The primary function of this role is to provide advanced professional input and leadership to complex Provider Relations assignments/projects. The Provider Relations Program Manager maintains positive relationships between the health plan and health care professionals and participates in work groups to develop processes to improve program satisfaction.

The Provider Relations Program Manager assists in the daily operations for managing the provider network, which includes recruiting, servicing, and training for health care professionals. This role is responsible for initiating and maintaining effective communication channels with contracted health care providers to ensure understanding of policies and procedures. In addition, the Provider Relations Program Manager prepares, analyzes, and reviews provider contracts and alternate contract terms.

**ESSENTIAL FUNCTIONS**:

- Responsible for developing and maintaining effective health care providers’ recruitment and retention programs
- Utilizes in-depth professional knowledge and acumen to develop models and procedures, and monitors trends within provider contracting
- Manages the smooth operation and administration of provider agreements by ensuring compliance with contracting guidelines
- Participates in contract negotiations by drafting and updating provider contracts
- Assume the role of Web Master and liaises with external provider associations and chains, software vendors to coordinate new projects, communications, procedures, etc.
- Provides professional leadership and oversees the day-to-day activity of the Provider Relations Communications team to ensure quality communication with healthcare providers, associations, provincial colleges, pharmacy chains, software vendors, third party suppliers and internal and external clients
- Provide ongoing guidance and support to the Provider Relations Communications team of direct reports by establishing and communicating clear goals for team members, providing feedback and conducting performance evaluations
- Foster a growth-oriented culture though coaching and mentoring to expend team proficiency, skill development to create bench strength and alignment with department goals
- Leads and manages projects and initiatives within Provider Relations that support the corporate/business objectives
- Works with functional leaders to create viable business cases by proactively identify industry trends, minimize risks for our customers, and bring the most value to the business
- Revises and maintains Provider Manuals, coordinating content and approvals internally (including with ESC legal)
- Has oversight on key performance indicators and creates standard methodology for conducting capacity analysis to support optimal resource allocation
- Aid in budgeting/forecasting for the department including creating vendor purchase orders
- As part of the Disaster Recovery (DR) team for the department, participates in regular DR exercises, DR communications and update Business Continuity Plans for the department
- Mentor and coach team members
- Additional duties as assigned by leadership.

**QUALIFICATIONS**:

- Post-secondary diploma, degree or equivalent experience
- Minimum of 5 years of related experience is required
- 3 + years of demonstrated leadership and mentorship experience strongly preferred
- Knowledge of managed healthcare/pharmacy, MS&E or Dental benefit administration and claims processing is an asset
- Demonstrated ability to coordinate cross-functional work teams to work collaboratively toward aligned project objectives
- Knowledge of project and program development, and cost benefit analysis
- Excellent verbal and written communication skills
- Bilingualism (French and English) is an asset
- Demonstrated interpersonal skills to facilitate change management
- Excellent time and resource management skills
- Self-driven, curious, ability to work independently with mínimal supervision
- Strong organizational skills and proven ability to manage competing priorities in a fast paced environment
- Strong focus on quality and accuracy
- Creative problem solver with positive influencing abilities

**NOTE: Internal posting will be closed on April 17, 2024.**

**Express Scripts Canada is a Cigna company**

Express Scripts Canada is a subsidiary of Express Scripts, a Cigna company. Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the h

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