Job Description
As a member of the Clinical Leadership team, the
Clinical Operations Director will report directly to the Chief Medical Officer (CMO) for Cigna Healthcare - IH and will be responsible for driving and supporting the development and execution of business priorities and goals. The role blends clinical insight with operational execution to enhance healthcare delivery, cost management, provider engagement and regulatory compliance. The job holder will be accountable for the following:
- Operational clinical leadership: partner with CMO to shape and advance clinical strategy across areas like value-based care, cost of care patient/provider experience and population health. Lead affordability planning and reviewing trends and required actions for further enhancements.
- Operational Oversight: Direct daily operations of clinical programs, ensure SLA adherence and manage team performance against volume forecasts. Drives and is accountable for the execution of Clinical operating plan, roadmap, project efforts, and major initiatives for US incurred Claims/Services.
- Team & Matrix Management: Lead a matrixed environment of internal clinical and ops staff.
- Process Improvement & Analytics: Use data driven approaches and tools to optimize workflows, track KPI performance and drive continuous improvement, and affordability initiatives in partnership with network and PI team. Accountable for analyzing affordability outcomes, to recognize and prioritize opportunities for improvement, and to inform actions based on clinical and business trends
- Risk & compliance management: Ensure clinical processes align with regulatory policy, quality requirements. Identify and mitigate operational risks.
- Communication & Governance: Lead governance around clinical programs. Create and deliver executive updates, business reviews and internal/external communications.
- Serves as a critical business partner , working in close partnership with the Clinical Solutions team, EviCore, Cigna Behavioral Health team, US Employer clinical team and key matrix partners. Partner closely with the XT team to represent International on key initiatives around prior-authorization, Cigna clinical policies & Medical cost containment.
- Gives clinical evidence-based advice on medical claims , considering internationally accepted protocols and local and/or regional customs and regulations.
- Actively monitors new and emerging clinical trends , practices, and solutions and assess their applicability to key business initiatives and business strategies
- Ensures attainment of quality , production, timeliness, cost containment goals, and excellent customer satisfaction for both internal and external customers and clients.
- Drives reporting improvements with Medical Economics, Finance and Data and Analytics for Commercial team use and be proficient in explaining and consulting
The successful candidate for this role will be execution-oriented, a collaborative leader, a facilitator, an open-minded innovator, a self-starter, a good listener, a change agent, a fact-based, critical thinker. They will lead within a matrixed environment, including internal associates, external partners and consultants throughout Cigna International.
QUALIFICATIONS - Current/recent leadership experience and ability to drive results in a highly matrixed organization required
- Prior experience in a clinical organization preferred
- Working understanding of and experience with operational reports and metric data, and comprehension of how to communicate that data to senior leaders and team members
EDUCATION - Doctorate Degree in Medicine (MD or DO) 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 230,600 - 384,400 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.
Job Tags
Permanent employment, Local area, Work from home,