Cigna
Program Management Senior Advisor - Evernorth - Hybrid
Cigna, Phoenix, Arizona, United States, 85003
Key Responsibilities:
Manage projects focused on strategic initiatives, supporting the full project scope and assessment to identify Health Management impacts end-to-end, including gaps, barriers, and issues that may affect project outcomes using 278 EDI logic.
Design, develop, and manage project workstreams that incorporate EDI to meet and exceed Health Improvement goals, such as clinical value metrics, cost savings, pilot implementations, quality improvement, and operational efficiency, utilizing appropriate project management tools to achieve measurable improvements in healthcare delivery, customer experience, and client satisfaction.
Support and oversee assessments of key project components utilizing 278 EDI logic and assist in the development, evaluation, and implementation of new or modified health products, programs, systems, and service delivery models.
Enhance and develop operational workflows for Health Management projects, including UM, CM, and Intake, collaborating with matrix partners and dependencies.
Manage multiple complex, time-sensitive initiatives across enterprise and multi-vertical teams aimed at delivering targeted health outcomes.
Define and advise on business and system requirements for assigned projects from end to end.
Lead project implementation, including organizational transitions within Health Management, partnering with SMEs and teams such as eviCore.
Collaborate with Product, Quality, Program Development, Compliance, and other operational teams to ensure project success.
Monitor daily data, proactively assess trends, and identify gaps or issues.
Communicate data outcomes effectively to business owners and identify impacted areas.
Specify system modification requirements and prioritize requests based on business needs.
Align and collaborate with various teams including Product, Clinical Operations, Pharmacy, Claims, Analytics, IT, and others.
Manage scenario testing related to 278 EDI and oversee post-implementation processes to identify trends and gaps.
Qualifications & Role Requirements: At least 5 years of healthcare or clinical operations experience with leadership roles in complex projects across matrix organizations.
Experience as a team leader or key member on complex projects or pilots resulting in successful execution.
Project Management/Six Sigma experience preferred, with proven success in executing complex projects.
Innovative mindset and adaptability to a dynamic, growth-oriented environment.
Ability to work effectively in fast-paced, changing environments with strong analytical skills.
Deep knowledge of Cigna products, clinical programs, and strategies.
Proven ability to work independently within a highly matrixed environment across geographies and departments.
Leadership and influencing skills in a matrixed environment are critical.
Strong negotiation, communication, presentation, and interpersonal skills.
Extensive knowledge of eviCore integration and EDI (278/275) processing, mapping, and business use.
Travel requirement: 10-20%.
For remote work, a broadband or fiber internet connection of at least 10 Mbps download and 5 Mbps upload is required. The annual salary range is $113,600 - $189,300, depending on experience and location, with eligibility for an annual bonus. Benefits include health coverage, 401(k), paid time off, and more. For details, visit Life at Cigna Group. About Evernorth Health Services: Evernorth, a division of The Cigna Group, provides innovative pharmacy, care, and benefit solutions to improve health and vitality, aiming to make healthcare more accessible and effective. We are an equal opportunity employer, considering all qualified applicants regardless of race, color, age, disability, sex, or other protected characteristics. Reasonable accommodations are available upon request by emailing SeeYourself@cigna.com. Our policies include a tobacco-free workplace in certain states. Criminal history considerations are in accordance with applicable laws.
If the following job requirements and experience match your skills, please ensure you apply promptly. #J-18808-Ljbffr Remote working/work at home options are available for this role.
Design, develop, and manage project workstreams that incorporate EDI to meet and exceed Health Improvement goals, such as clinical value metrics, cost savings, pilot implementations, quality improvement, and operational efficiency, utilizing appropriate project management tools to achieve measurable improvements in healthcare delivery, customer experience, and client satisfaction.
Support and oversee assessments of key project components utilizing 278 EDI logic and assist in the development, evaluation, and implementation of new or modified health products, programs, systems, and service delivery models.
Enhance and develop operational workflows for Health Management projects, including UM, CM, and Intake, collaborating with matrix partners and dependencies.
Manage multiple complex, time-sensitive initiatives across enterprise and multi-vertical teams aimed at delivering targeted health outcomes.
Define and advise on business and system requirements for assigned projects from end to end.
Lead project implementation, including organizational transitions within Health Management, partnering with SMEs and teams such as eviCore.
Collaborate with Product, Quality, Program Development, Compliance, and other operational teams to ensure project success.
Monitor daily data, proactively assess trends, and identify gaps or issues.
Communicate data outcomes effectively to business owners and identify impacted areas.
Specify system modification requirements and prioritize requests based on business needs.
Align and collaborate with various teams including Product, Clinical Operations, Pharmacy, Claims, Analytics, IT, and others.
Manage scenario testing related to 278 EDI and oversee post-implementation processes to identify trends and gaps.
Qualifications & Role Requirements: At least 5 years of healthcare or clinical operations experience with leadership roles in complex projects across matrix organizations.
Experience as a team leader or key member on complex projects or pilots resulting in successful execution.
Project Management/Six Sigma experience preferred, with proven success in executing complex projects.
Innovative mindset and adaptability to a dynamic, growth-oriented environment.
Ability to work effectively in fast-paced, changing environments with strong analytical skills.
Deep knowledge of Cigna products, clinical programs, and strategies.
Proven ability to work independently within a highly matrixed environment across geographies and departments.
Leadership and influencing skills in a matrixed environment are critical.
Strong negotiation, communication, presentation, and interpersonal skills.
Extensive knowledge of eviCore integration and EDI (278/275) processing, mapping, and business use.
Travel requirement: 10-20%.
For remote work, a broadband or fiber internet connection of at least 10 Mbps download and 5 Mbps upload is required. The annual salary range is $113,600 - $189,300, depending on experience and location, with eligibility for an annual bonus. Benefits include health coverage, 401(k), paid time off, and more. For details, visit Life at Cigna Group. About Evernorth Health Services: Evernorth, a division of The Cigna Group, provides innovative pharmacy, care, and benefit solutions to improve health and vitality, aiming to make healthcare more accessible and effective. We are an equal opportunity employer, considering all qualified applicants regardless of race, color, age, disability, sex, or other protected characteristics. Reasonable accommodations are available upon request by emailing SeeYourself@cigna.com. Our policies include a tobacco-free workplace in certain states. Criminal history considerations are in accordance with applicable laws.
If the following job requirements and experience match your skills, please ensure you apply promptly. #J-18808-Ljbffr Remote working/work at home options are available for this role.