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Medicare Clinical Operations Senior Director- Work from Home
Remote, Work from home, United States
Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation.
The Medicare Clinical Operations Senior Director will report to the Chief Medical Officer (CMO) and is a member of the CMO’s Senior Leadership Team. This role will provide leadership to the clinical teams and work with the CMO in all aspects of clinical strategy and operations. The role will be responsible for differentiating and compliant clinical outcomes through a commitment to operational excellence. In addition, this role will partner closely with key matrix partners within our Medicare Advantage business, including CMO, Quality, MA markets, Finance, Analytics, and Service Operations to ensure the Clinical Operations department is well positioned to deliver on membership growth and retention strategies.
Will be accountable for leadership, vision, and direction in planning, developing, implementing, and managing the Medicare Advantage clinical operations. This includes Utilization Management, Care Management (including Special Needs Plans), Behavioral Health, and Operational Readiness. Will oversee the delivery of operational clinical services, quality and efficiency by monitoring and adjusting operating procedures and practices in order to meet compliance expectations and achieve organizational goals. This role will also provide direction to operational leaders in order to ensure adherence to operational protocols, evidence-based best practices, and delivering on targeted outcomes.
– Leads management oversight of all clinical operational areas end–to-end management for Medicare Advantage Clinical Operations.
– Leads the business planning process for Clinical Operations to determine strategic business and investment priorities.
– Ensures alignment of strategy, structure, systems and skills to create and sustain a competitive, high performing operational organization.
– Provides management oversight of end-to-end business operational readiness activities related to deployment of business initiatives and capabilities.
– Manages the performance of Clinical Operations to ensure strong operational productivity, quality and financial objectives are achieved.
– Assesses and mitigates business, compliance and financial risks related to Clinical Operations.
– Effectively manages and maximizes relationship with key functions/matrix partners that create synergies and new opportunities as well as ensures alignment of priorities and resources with business strategy/goals.
– Collaborates with key partners to drive relentless focus on the customer, provider and client.
– Bachelor’s Degree; Advanced Clinical Degree from an accredited school and hold applicable licenses preferred.
– Minimum of ten years of Medicare Advantage clinical experience is required.
– Minimum of ten years of experience in large operations, medical management, utilization review and/or case management in a managed care setting.
– Previous experience managing physicians, nurses or employees.
– Proven ability to lead cross-functional teams and drive results with strong sense of urgency.
– Experience with managing multiple projects in a fast-paced matrix environment.
– Demonstrated ability to educate colleagues and staff members.
– Previous experience leading extensive change in a dynamic business environment.
– Demonstration of strong and effective abilities in teamwork, negotiation, conflict management, decision-making, and problem solving skills.
– Successful ability to assess complex issues, to determine and implement solutions, and resolve problems.
– Success in creating and maintaining cooperative, successful relations with diverse internal and external stakeholders.
– Strong communication skills with ability to convey complex and technical information in an understandable way; both oral and written communication.
– Ability to analyze complex information and draw relevant conclusions, including analyzing & reporting on utilization management and unit cost trends.
– Demonstrated sensitivity to culturally diverse situations, participants, and customers/members.
– Product development, marketing, sales and business acumen experience a plus.
– Must be familiar with quality management principles and processes.
– Knowledge of current theory and practice in mental health/substance abuse treatment and care management.
This position is not eligible to be performed in Colorado.
Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you’ll enjoy meaningful career experiences that enrich people’s lives. What difference will you make?
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