Cigna Medicare Clinical Operations Program Management Lead Analyst- Remote- Cigna Healthcare

Position Scope:   

• Responsible for all CMS deliverables for Clinical Operations
• Leads all internal/external audit activities
• Serves as liaison with Compliance.
• Creates and implements process improvements and updates.
• Establishes and manages operational and business readiness processes to ensure the successful implementation of funded projects, baseline maintenance/fix, infrastructure upgrades, as well as operational changes impacted by process changes
• Participate in business requirements to ensure applicability to operational areas when changes are implemented
• Responsible for tracking key project and release milestones, escalating risks, confirming mitigation plans and adjusting plans and/or resources to meet the needs of customers and CMS timeframes.

• Experience in the use of project management methodologies and tool a plus

Major responsibilities and desired results:

• Responsible for all CMS deliverables. Lead responses ensuring accurate, complete submission.
• Lead discussions with Compliance and Business to identify impacts to processes as a result of changes in regulations (HMPS memos).
• Tracks and drives to completion the resolution of Corrective Action Plans (CAPs); works with business owners to drive timely closure.
• Creates and maintains all policies and procedures for the functional area.
• Responsible for continuous process improvement activities.  Documents current and future state.  Leads change management activities associated with updates to processes.
• Collaborates with leadership to prioritize projects.
• Establishes and executes end to end universe data validation.  Includes review and correction of data integrity issues in source systems.
• Lead operational readiness and implementation to ensure teams are prepared for changes impacting business functions, roles, people and processes.
• Drive and strengthen partnerships with Business Development Team, Compliance and IT, to ensure successful identification of business impact, communication, procedures, training, delay, and business checkout needs.
• Build and maintain appropriate business readiness communication processes and engagement models to accommodate frequent internal and matrix partner organization changes.
• Maintain efficient and informative lines of communication between business and matrix partner leadership.
• Enhance established processes and engagement models as needed to ensure business readiness. 
• Identify and execute process improvement opportunities and eliminate barriers to improve quality, implementation readiness, and reduce rework.
• Bring together Business and IT leadership to resolve escalated conflicts.
• Maintain strong partnerships and collaborate with matrix partners.  Enforce adherence to established processes and engagement models.

Minimum Requirements:

• Operations experience preferred in Utilization Management and Special Needs Plans; Clinical or nursing background and knowledge of FDR/IPAs a plus
• Medicare Advantage experience preferred with focus on regulatory compliance or auditing
• Demonstrated process implementation/improvement experience Knowledge of NCQA requirements a plus
• Strong analytical and problem solving skills Excellent communication skills and ability to interact with all levels and diverse partners
• Strong influencing and negotiation skills. 
• Ability to influence without authority. Independent, quick learner with ability to impart knowledge to others effectively
• Previous leadership experience preferred
• Ability to build solid working relationships with staff, matrix partners, customers and providers
• Strong knowledge of Microsoft Office products including Excel, PowerPoint, Word, and Project.
• Travel occasionally required up to 15%
• Required to work over occasional weekends and odd hours: Program Audits, System Releases Bachelor’s Degree or relevant work experience preferred

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an annual salary of 74,600 - 124,300 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group.

About Cigna Healthcare

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

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