RN Clinical Program Consultant - Hybrid - Connecticut (cigna)

Job Description

General Purpose:

Cigna's mission is to improve the health, well-being and sense of security for those we serve. The Clinical Sales and Network Organization, as Champions for affordable, predictable and simple health care, is dedicated to achievement of our Enterprise goals improving affordability and customer health outcomes, client growth and retention, and network performance.

OVERVIEW:

The Nurse Executive Clinical Program Sr. Advisor, as part of the Clinical Sales and Network Organization, is closely aligned with Clients, Network Provider Partners and Key Stakeholders to support improved healthcare quality and affordability while ensuring client/customer satisfaction. The Clinical Program Sr. Advisor executes on strategic priorities to meet organizational goals related to Client Growth and Retention, Total Medical Cost and Value-Based Provider Performance.

GENERAL RESPONSIBILITIES:

• Represents Clinical Performance and Quality (CP&Q) and the Clinical Sales and Network Organization (CSNO) externally and internally as a Clinical Leader and Advocate.
• In partnership with the Medical Executive, applies fundamental knowledge of business segment strategies, distribution channels, healthcare industry trends and Cigna programs and services to deliver clinical insights and consultancy in support of Growth, Retention, Affordability and improved Network Performance.

• As CSNO Stakeholder, participates in special projects for key business initiatives as assigned, providing technical, clinical and/or business expertise at the Market, Regional or National level
• As Clinical SME and healthcare industry expert, participates in cross-functional teams at the local or national level, identifying and implementing actions that improve organizational or enterprise effectiveness and Affordability. 
• Supports the connection between Cigna Health Plan and EverNorth services: Care Coordination, Clinical and Behavioral Operations, ES, Accredo, Evicore and Healthcare delivery, identifying pathways to improve collaboration and performance that result in positive outcomes for our providers, clients and customers.
• Responsible to provide clinical insights, education and guidance to Segment/Market Leadership and external stakeholders (clients, producers/brokers, provider partners, others).
• Supports RFI/RFP process and finalist meetings toward achievement of growth and persistency targets
• In conjunction with CAC team, facilitates provider supported Client/Producer meetings and events to educate, inform and support Cigna's integrated value, our Connected Care strategy
• In partnership with Sales, Clinical Operations, Health Engagement and others, supports process to identify and execute opportunities that grow alignment to our CACs, CCD and other High Performing Provider Partners
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• Investigates escalated clinical inquiries, providing explanation on benefit and coverage position to sales, client and/or broker as indicated

FOCUS AREA RESPONSIBILITIES: SALES

• Supports Growth and Persistency across all U.S. Commercial Sales including Taft-Hartley, Allegiance and other growth segments as identified per Enterprise Strategy

• Clinical Liaison and Advisor for assigned segment or market account team (Sales, SL, UW, Client Reporting, Wellness) , Cigna clinical operations and external stakeholders (client/broker/other)
• Maintains a working knowledge of all clinical, health advocacy and operational processes necessary to educate, update and offer insights to account teams, clients, brokers and other key stakeholders. 

• As Clinical Advisor, supports client utilization review and strategy meetings, providing medical cost trend, large claim and benefit analysis and offering recommendation on interventions that positively impact affordability, customer engagement and quality health outcomes.
• Supports new business growth including prospective review, new client onboarding and new clinical product implementations
• Coordinates with Sales and Operations to facilitate TOC, including claims-based care management jumpstart process and resolution of escalated case TOC issues.
• Promotes value of integration and program engagement through broker/client education, incentive strategies and case management/coaching referrals to appropriate clinical operations team as indicated
• Supports and facilitates client related engagement events (worksite events, health fairs, lunch and learns, wellness councils, other) in coordination with sales, clinical operations, wellness team.
• Serves as clinical liaison for employer sponsored medical clinics to promote coordination of care and engagement in Cigna programs and services
• Served as account team clinical POC, responds to and facilitates resolution to complex clinical issues and non-standard client benefit requests
• Partnering with Sales and Clinical Operations, supports cultural trainings, readiness assessments, vendor integrations and audits to ensure a seamless onboarding and continued positive client experience

FOCUS AREA RESPONSIBILITIES: NETWORK/AFFORDABILITY

• Maintains requisite knowledge of Cigna's value based programs, tools and resources
• Fosters effective relationships with assigned CAC provider groups in support of performance improvement in cost and quality
• As a clinical point of contact for Cigna's Value-Based Provider Partner/s, is responsible for the relationship with the ECC (Embedded Care Coordinator/s), interacting onsite and virtually to ensure an effective Key Focus Action Plan (KFAP)  is developed and enacted to drive optimal performance and achievement of value based goals
• In partnership with Medical Executive and Collaborative Care (CCC) Program Team, consults regularly with the provider partner on performance results, engagement and KFAP activities that drive CCC program success in quality, affordability and experience of care. Presents to Provider Partner Leadership at the direction of or in lieu of the Medical Executive
• Conducts value-based provider partner infrastructure integrity assessments, influencing adoption of advanced practice tenets and clinical capabilities that support PHM and clinical integration integral to long term success
• Serves as liaison to enable the connection between Cigna’s Clinical Operations  and HealthCare Delivery Systems, identifying  pathways to improve collaboration and  integrated/coordinated care that optimize outcomes for our Clients and Customers
• As member of the local market TMC (Total Medical Cost) team, partners on  opportunity analysis and execution of initiatives to drive trend and cost of goods sold (COGs) reduction that improve customer/client affordability 
• Serves as clinical SME to educate, inform and promote Cigna/s  CAC program value to sales, clients, brokers and others

Qualifications:

• Active and unrestricted RN Nursing License
• Required Bachelor’s degree, Advanced Degree preferred

• Minimum of three (3) years of clinical practice experience

• Proven industry experience in  a Health Sector related field (Health Insurance; Healthcare Professional and/or Delivery System Entities or Allied Health Industry)

• Strong Leadership, Organizational Savvy, Critical Thinking and Execution skills

• Works effectively in a matrixed environment
• Sensitive to culturally diverse situations with proven ability to foster and maintain cooperative successful relations with diverse internal and external stakeholders.

• Proven ability to build strong relationships, foster collaboration and influence diverse teams
• Excellent oral and written communication skills. Comfortable presenting internally (team or matrix partner forums) and externally (Clinicians, Clients and Brokers)
• Proficient in using Microsoft and Technology/Software applications

Requires intermittent travel per assignment Up to 40%

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 116,200 - 193,600 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.