The Cigna Group Looking for Provider Relations Program Manager – Express Scripts Canada at Ontario 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 minimal 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

• Advanced knowledge and experience with computer applications (MS Office)

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 health, wellbeing and peace of mind of those we serve. Cigna offers an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioural health, pharmacy, vision, supplemental benefits, and other related products.

About Express Scripts Canada

Express Scripts Canada is a leading health benefits manager and has been recognized as one of the most innovative. Our clients include Canada’s leading insurers, third party administrators and governments. We work with these clients to develop industry-leading solutions to deliver superior healthcare in a cost-controlled environment. We provide Active Pharmacy™ services to more than 7 million Canadian patients and adjudicate more than 100 million pharmacy, dental, and extended health claims annually. Through our proprietary consumer intelligence, clinical expertise, and patients-first approach, we promote better health decisions for plan members, while managing and reducing drug benefit costs for plan sponsors.

It will be a condition of employment that the successful candidate obtains an Enhanced Reliability Clearance from the Federal Government. The candidate will be required to provide supporting documentation to receive clearance if required.

We offer a competitive salary and benefits package, along with a positive work environment built on solid corporate values, integrity, mutual respect, collaboration, passion, service and alignment.

We are an equal opportunity employer that promotes a diverse, inclusive and accessible workplace. By embracing diversity, we build a more effective organization that empowers our employees to be the best that they can be.

We are committed to creating a working environment that is barrier-free and we are prepared to provide accommodation for people with disabilities.

If you require accommodation in completing the online application process, please email: [email protected] Do not email [email protected] for an update on your application or to provide your resume as you will not receive a response.