Clinical Quality Management Director - Hybrid - (RN Preferred) (Finance)

Job Description Summary

The Clinical Program Director sets clinical strategy to drive improvements in health, patient experience, and health disparities. This position will create a high performing team who will be deployed to plan and execute innovative solutions to tackle significant clinical challenges impacting health, total cost of care, patient experience, health equity, and other opportunities. This role involves strategic planning, implementation, and evaluation of health improvement initiatives with a strong focus on generating quantifiable results. The ideal candidate will possess strong leadership skills, clinical expertise, and a commitment to advancing patient care.

Specific responsibilities include but are not limited to: analyzing and appraising management as to performance of insurance products using measurement criteria; collecting and analyzing data, identifying variance and unacceptable performance, and working across the enterprise to establish innovative solutions to drive results. Utilizes in-depth professional knowledge and experience to set priorities. Focuses on achievement of enterprise, segment, and local goals and plays a significant role in communicating results, value, and learnings from initiatives.

Job Description

Enterprise Quality & Accreditation is seeking a dynamic, highly motivated, strategic, and results oriented leader to manage and lead a team of individuals responsible for designing, executing, and evaluating clinical initiatives to drive improved health outcomes. This leader sets clinical strategy and works with the team to create new and compelling clinical initiatives to improve health and assure Cigna's competitive positioning in the marketplace.

This role drives continuous improvement of clinical measures through partnership with matrix leaders in multiple clinical areas of the organization including but not limited to: Clinical Operations, Contracting, Data Interoperability, IT, Digital Solutions, Legal/Compliance, Care Solutions, Accreditation Programs, and the US Commercial Quality Organization. This role will additionally partner with external partners to support specific pilots and initiatives. Must be adept at leveraging technology and multiple modalities to drive operational and clinical improvements while managing program expenses, through strategies including: vendor re-negotiation, new technology support and outsourcing. Must maintain current view of competitive landscape and drive modern approaches to impact behavior change. Drives ongoing improvement in results while meeting the demands of a dynamic and changing industry, and supports future growth as the organization advances towards Cigna's Drive to 2025 goals. Supports Cigna's continued success as a Global HealthCare Company by assuring that results align with Cigna's mission.

Specific Duties

• Program Development and Implementation: Design, develop, and implement innovative clinical programs aimed at improving patient health outcomes and addressing clinical gaps.
• Strategic Planning: Collaborate with senior leadership to develop strategic plans for program growth and effectiveness, aligning with organizational goals and priorities.
• Data Analysis and Evaluation: Utilize data analytics to assess program effectiveness, identify areas for improvement, and ensure evidence-based practices are applied.
• Team Leadership: Lead, mentor, and manage multidisciplinary teams involved in program execution, ensuring alignment with clinical objectives and standards.
• Stakeholder Engagement: Work closely with healthcare providers, patients, and other stakeholders to foster collaboration and support for program initiatives.
• Compliance and Quality Assurance: Ensure programs comply with regulatory requirements, privacy standards, and organizational policies. Implement quality assurance measures to maintain high standards of care.
• Budget Management: Set and manage program budgets, allocate resources efficiently, and ensure financial sustainability of program initiatives.
• Continuous Improvement: Stay abreast of industry trends, emerging practices, and advancements in healthcare to continuously enhance program effectiveness and patient outcomes.
  • Strategy: Sets strategy and priorities for the deployment of staff to establish national, market-level and measure specific clinical quality and patient experience initiatives for the enterprise.
  • Design & Execution: Oversees the design and implementation of clinical quality initiatives, studies, and pilots to improve HEDIS© results, patient experience, enterprise quality opportunities. Analyzes results and develops annual strategy and plan to address high impact and clinically meaningful opportunities.
  • Innovation: Ability to lead innovation strategically by identifying value opportunities and partnering with matrix operational, clinical, and technology teams to implement and achieve value
  • Team Development: Builds, develops and inspires a positive and high performing team and culture:
    • Creates a sense of purpose/meaning for the team that aligns with Cigna's value and mission.
    • Supports and promotes appropriate team alignment and process improvement work.
    • Provides coaching and development to teams, in particular, direct reports for succession planning and overall career growth.
    • Fosters an effective work environment and ensures employees receive appropriate communication, recognition and development.
    • Creates, leads, and directs a culture of innovation with the application of human-centered design tools, techniques, and methods. Ensures timely voice of the customer is solicited to identify the unique needs of customers in key geographies. Facilitates multi-disciplinary workshops and ideation sessions. Brings emerging concepts to life through prototyping to communicate ideas in compelling ways to test initiatives and understand how the end user will respond.

• Partnership: Matrix partnership will be key to success in this role as priorities will likely scan multiple teams and be enabled in strong partnership with many areas across the enterprise including but not limited to: Care Solutions, Digital IT, Automation, Data Interoperability, provider contracting, market facing support, etc.
• Segment Support: While the role has an enterprise scope, the role provides ongoing support to the Individual Family Product segment and US Employer segment through clinical initiatives designed to optimize the HEDIS and Quality Star Ratings (QRS). Encourages participation of matrix partners in regional quality analysis and planning, resulting in improved coordination of activities across the organization.
• Process Management: Directs consistency of process application across all market aligned teams while allowing for variation to best support the unique needs of the local market population. Directs budgeting and assures that funding and resources are optimized
• Directs Project Leadership: Serve as point of contact for potential incoming projects specific to clinical quality improvement that will impact resources; work with appropriate matrix partners to determine net business impact of project deliverables and identify/deploy appropriate subject matter expertise.
• Training and Coaching: Leads the Clinical Quality Senior Advisors and functions; Leads the broader team in alignment with CP&Q's talent priorities. Assures training material and standard operating procedures are easy to understand; provide formal feedback loop to support staff development, e.g., coaching, trends, learning sessions, etc.
• Management: Directs all operations relative to Clinical Quality Improvement to assure that Cigna operates in an environment of continuous improvement.
• Communication: Prepares and presents as needed the results of key prioritized initiatives to department, leadership, matrix partners, and externally as needed.

Ideal Candidates will offer the following:

• Education: Master's degree in Public Health, Healthcare Administration, Nursing, or a related field. Clinical licensure preferred (e.g., RN, MD, or similar).
• Experience: Minimum of 5 years of experience in a clinical or healthcare management role, with at least 3 years in program development, solution design, or developing proven interventions. Successful and experienced empathetic people leadership is essential to building and leading a high performing team.
• Skills: Strong leadership, organizational, and analytical skills. Proficiency in data analysis, program evaluation, data exchange, and automation. Excellent written and verbal communication and interpersonal skills.
• Knowledge: In-depth understanding of healthcare systems, clinical practices, and quality improvement methodologies.
• Leadership:
  • A strong bias towards action and driving results
  • An intellectual curiosity, be enterprising by nature, and a blend of ingenuity with business acumen.
  • Extensive experience leading design thinking programs and workshops, especially with multi-disciplinary teams.
  • Strong clinical knowledge, knowledge of behavioral economics and how to influence individuals to take action.
  • Experience leading efforts to rapidly test and learn and pivot or scale initiatives.
  • Experience assembling and leading diverse teams. Experience with geographically disperse teams is a plus.
  • A strong belief in the power of teamwork and respect for diverse thinking where collaboration is considered a must for delivering the greatest success.
  • An open mind, a positive attitude, and a sense of humor.

Qualifications

• Bachelor's Degree Nursing, Behavioral-related field, Public Health, and/or other Health Related Field preferred.
• Advanced degree in Nursing, Public Health or Business strongly preferred.
• Strong clinical background in diverse settings; seasoned, respected quality leader with a minimum of 5 years of quality management experience in the healthcare industry, with specific experience in managing clinical quality initiatives in a managed care setting.
• Clinical design experience strongly preferred.
• Proven capabilities in strategic planning and large-scale project management.
• Demonstrated ability to think/act strategically from a program value perspective and influence key leaders and matrix partners.
• Strong communication and facilitation skills with all levels of the organization, including ability to resolve issues and build consensus among groups of diverse internal/external stakeholders.
• Proven track record of leading teams to drive improved outcomes performance through measurement and successful execution of quality strategy.
• Strong managerial courage and the ability to challenge the status quo and lead change
• Highly driven and strategic leader focused on developing the team to achieve results and highest value yield
• In depth and strong working knowledge and experience and understanding of Quality Management, NCQA Accreditation, Population Health, Health Equity and Accreditation requirements; and a working knowledge/experience in HEDIS operations and technical specifications.
• Strong knowledge and experience in qualitative and quantitative data analysis, study design and basic statistics, ability to create dashboard metrics and reports.
• Strong communication skills - both written, visual, and verbal - and an ability to succinctly communicate quality stories in a way that is easy for all stakeholders to understand at all levels.
• Experience with digital and visual communications is a plus.
• Demonstrated ability to develop a strategic roadmap and priorities at the market and measure level, to influence key leaders and matrix partners; ability to manage multiple projects simultaneously.
• Demonstrated ability to work in a highly matrixed environment; ability to positively manage change and proactively respond to emerging trends.
• Strong supervisory skills and experience leading multi-disciplinary teams, , training, coaching, and developing..
• Excellent communication, influencing and negotiations skills, demonstrated ability to work effectively with all levels and matrix relationships.
• Experienced in leading innovative clinical initiatives.
• Ability to manage multiple projects to schedule and within budget.
• Ability to create and sustain a positive, inclusive, highly engaged team culture.
• CPHQ, Project Management, or Lean Six Sigma certification 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.

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.

Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link .

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 145,100 - 241,900 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 and long term incentive 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.