Rn Clinical Program Senior Advisor - Remote - Metro Phoenix, Arizona And Surrounding Cities

GENERAL RESPONSIBILITIES:
Represents Clinical Performance and Quality (CP&Q) and the Market Facing Clinical Organization (MFCO) 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 MFCO 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
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.
Ideal candidate must reside in Metro Phoenix,Arizona or Surrounding Cities.
Qualifications:
Active and unrestricted 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
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 109,500 - 182,500 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: [email protected] for support. Do not email [email protected] 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.