Program Management Lead Analyst - Encore Program - Remote

Please Note: This position is part of The Cigna Group's Encore program designated exclusively for eligible retirees of the company. Candidates must meet the program requirements to be considered.

Description:

The Clinical Performance & Quality (CP&Q) organization drives improved health outcomes, affordability, and satisfaction, by engaging our customers, clients, and providers, developing clinical policies, guidelines, and meaningful measurements, aligning incentives, and building personal connections. This approach helps ensure that we are supporting Cigna's enterprise goals of putting the needs of our customers at the center of all we do, being the industry’s undisputed partner of choice, and accelerating the pace of innovative change.

Position Summary:                                                                                                                   

The Program Management Lead Analyst supports our CP&Q Clinical Sales & Network Team (CSNO). C Clinicians represent Cigna externally and enable the successful alignment between complex Client needs and Provider Partnerships by leveraging Cigna's Clinical Programs, Products, and Services. The Program Management Lead Analyst is responsible for researching, analyzing, summarizing, and presenting relative conclusions to our MFCO clinicians to help identify factors negatively impacting our customers’ health and align solutions to overcome these obstacles. The Clinicians leverage these findings to better help support the Sales Organization for key Cigna clients and contribute toward the successful execution of Value-Based partnerships such as Cigna’s Collaborative Care Organizations (CCC), by working cross-organizationally to influence and drive change that results in improved quality, affordability and satisfaction for our customers.

Responsibilities:

• Completion of the clinical summary and care management summary for High Cost Claimant reporting, following corporate guidelines

• Completion of high cost claim review for client Early Alert Process

• Research and presentation of findings to support the Market Medical Executive / Clinical Consultant to facilitate timely problem resolution

• Performs root cause analysis on escalated issues and recommends system/ process improvement to leadership for improvements/ corrections

• May lead a small to mid-sized project to implement recommended improvements

• Provides tracking and trending reports to management on the reasons and costs of escalated issue resolution

• Utilize critical thinking to identify and present resolutions to escalated issues

• Work with multiple matrix partners in a fast paced environment

• Navigation in ICMS, HC ICMS, TruCare, HEV, OneView, and Facets

• Understanding of Cigna's basic clinical programs

Qualifications:

• Minimum of 5 years of clinical or clinical support background required.

• High level of expertise in analyzing and researching clinical information and providing business recommendations for improvement and process efficiency in a matrix environment. 

• CPT coding experience.

• Excellent time management, organizational, research, analytical, communication and interpersonal skills with demonstrated ability to build strong relationships and influence diverse teams

• Demonstrates Flexible, Consultative Critical Thinking and Action planning

• Outstanding verbal and written communication skills.

• Proficient in Microsoft Outlook, Excel and Word

• Must meet Encore program criteria as a retired employee of The Cigna Group

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.

About The Cigna Group

Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. 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 wit