Director of Clinical Operations

4 days ago

St Louis, Missouri, United States The Cigna Group Full time
About the Role

The Cigna Group is seeking a highly experienced and skilled Director of Clinical Operations to lead our Coverage Review Operations team. As a key member of our leadership team, you will be responsible for the daily oversight and management of a large team of internal and external representatives, providing clinical services to health plans and pharmacy benefit managers.

Key Responsibilities
  • Operational Leadership: Provide direction and oversight to the Coverage Review Operations team, ensuring the delivery of high-quality clinical services that meet client expectations and regulatory requirements.
  • Team Management: Lead and develop a team of professionals with varying levels of subject matter expertise, providing guidance and support to ensure successful outcomes.
  • Strategic Planning: Collaborate with senior leadership to develop and execute strategic operations roadmaps, aligning with volume and channel forecasts and client Performance Guarantees and Service Level Agreements.
  • Global Service Partnerships: Partner with outsourced leadership to ensure the success of our Global Service Partners (GSPs), motivating and directing them to achieve top performance against quality, operational efficiency, and adherence to policy, procedure, and defined process.
  • Operational Performance: Own and manage operational results and outcomes, ensuring the delivery of optimal provider and member experiences.
  • Business Process Improvement: Identify opportunities for process improvement and work with partners to implement changes, driving continuous improvement and advancing provider and member experiences/partnerships.
  • Leadership Development: Attract, retain, and develop top talent, providing strategic thought leadership and driving continuous improvement to advance provider and member experiences/partnerships.
Requirements
  • Education: Bachelor's Degree; Advanced degree strongly preferred.
  • Experience: 8 plus years of relevant experience, including experience developing and executing core operations functions and strategies.
  • Leadership Skills: Proven track record of success in senior leadership positions, with experience leading large teams and managing complex operations.
  • Business Acumen: Strong business and financial acumen, with the ability to manage change, timelines, and balance multiple deadlines in a fast-paced environment.
  • Communication Skills: Strong written and verbal communication skills, with the ability to interact effectively with all levels of management, including executives, employees, customers, and Global Service Partners.
  • Industry Knowledge: General understanding of healthcare and health insurance businesses and regulatory/CMS guidelines.
Leadership Competencies
  • Delivers Results: Pushes team and cross-functional partners to deliver needed results in tough circumstances and expedited timelines.
  • Builds Effective Teams: Builds strong identity teams that apply their diverse skills and perspectives to achieve common goals.
  • Manages Complexity: Makes sense of complex and sometimes contradictory information to effectively solve problems.
  • Manages Ambiguity: Operates effectively and drives work forward even when things are not certain or there is no clear way forward.
  • Collaborates: Quickly builds partnerships and works collaboratively with others to ensure progress.

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