Cigna Director Clinical Operations in Bedford, Texas
Responsible for or key team member to:
•Provides vision and leadership for daily operations of clinical and non-clinical staff to ensure timely and effective processing of authorizations
•Responsible for the development and delivery of the Cigna-HealthSpring Behavioral health program which includes case management, counseling, authorization review and service coordination.
•Accountable for executing a high performing quality program to ensure that Cigna-HealthSpring meets or exceeds all Texas Medicaid Quality metrics including: HEDIS, CAHPS, P4Q, Potentially Preventable Events(PPE’s), etc
•Demonstrate knowledge and application of State contracts and manuals to ensure all Utilization Management, Behavioral health and Quality are meeting contractual and performance measures
•Research and define operational effectiveness within the team to generate innovative ideas that advance the efficiency and effectiveness of the clinical programs.
•Demonstrate data-driven, solutions-based on orientation to drive results for our clients/customers.
•Clinical program evaluations with recommended design enhancements and quality improvements, consulting with and providing recommendations to key stakeholders.
•Provides leadership and direction to team for assigned clinical programs and advance clinical development to assure clinical/health advocacy program integrity and results, supporting vendor integration through clinical program education, and process and workflow development.
•Active participation in clinical design, development and support launch of pilots/proof of concepts focused on improvement of health outcomes including increasing the likelihood of desired outcomes [compared to a baseline] and reducing health disparities among specified populations
•Exudes self-motivated ownership of clinical metric-driven results, continually acting with a sense of urgency to ensure that results are attained, if not exceeded and to champion perpetual change within Cigna-HealthSpring to ensure that we anticipate market needs.
•Collaborating with Informatics/Analytics and other key metrics partners to understand results and define areas of clinical opportunity- advancing the performance of our programs and services
•Recognize and impact service utilization patterns in order to improve clinical outcomes
•Identify and mitigate high dollar claim trend patterns.
•Responsible for demonstrating consistent improvement in Quality outcomes year or year
•Provides regular business cases in order for team to achieve financial results
•Focused improvement and innovative pilots to support the prevention of avoidable hospital admissions, readmissions, medical emergencies, across our customer base.
•Bachelor degree in Nursing, Healthcare Administration or other Health Related Field
•Advanced degree or certifications a plus.
•Minimum of 5-7 years of managerial experience in the healthcare industry with varied leadership responsibility.
•Current or recent clinical operation leadership experience in case management.
•Experience as a team leader involving complex projects, pilots or new customized solution resulting in successful execution to plans.
•Innovative and open to new ideas in a focused, intense and growth oriented environment.
•Strong analytic thinking and able to generate ideas from industry studies, reports, research and able to support root cause analysis to generate new innovative ideas and concepts.
•Clinical operation experience with key leadership responsibilities involving complex projects across multiple matrix organization.
•Extensive knowledge of the Medicaid industry to include a deep understanding of managed care, care management, disease management and health advocacy.
•Demonstrated experience and exceptional ability to work productively in a matrix management environment across geography, departments and position level.
•Previous experience as a clinical operation implementation team leader or key team member involving complex projects, pilots or new customized solution resulting in successful execution to plans.
•Action oriented, works with a sense of urgency and takes responsibility to execute to meet aggressive timelines.
•Strong communication and presentation skills and an ability to influence at multiple organizational levels.
•Strong interpersonal, networking and negotiations skills.
•Travel potential- 25 %
Primary Location: Bedford-Texas
Work Locations: 2208 North Highway 121 STE 210 Bedford 76021
Job: Med Mgt--Medical Services
Employee Status: Manager of People
Job Type: Full-time
Job Level: Day Job
Travel: Yes, 25 % of the Time
Job Posting: Jan 11, 2018, 3:13:55 PM
Cigna is an equal opportunity employer, which means we offer equal treatment to all applicants. Cigna does not discriminate, either directly or indirectly, on the grounds of race, color, sex, gender identity, sexual orientation, nationality, national origin, ethnic origin, religion, beliefs or creed, age, disability, marital status, veteran status or genetic information in any area of recruitment. In some countries we ask for information on the ethnic origin, gender and disability of our applicants for the purpose of monitoring equal opportunity. If you have a disability and would like to indicate as part of your application any relevant effects of your disability and any adjustment which you consider should reasonably be made to the process to assist your application, please do so in the relevant field during the application process.