OverviewThis position is responsible for service innovation and product design, focused on advancing behavioral’ s current and future clinical and health advocacy programs using evidenced based best clinical practices, opportunity analytics. Using a value-based design approach, and other design methods (proof of concept), the Clinical Program Advisor is responsible for independently executing “test and learn” pilots along with current program enhancements. Critical focus on advancing our programs and care approaches, aligning with the provider/delivery system in support of delivering better quality outcomes, a better patient experience while holding down cost – the Triple Aim.The team has responsibility for collaborating and aligning with clinical teams across the enterprise, solutions, operations, analytics, network, and IT partners. This role will have a strong focus on supporting development of business and technical requirements and will requiring learning and owning components of applications.Key Responsibilities (not limited to):Clinical Program design focused on health improvement goals, driving healthcare costs down and meeting organizational targets. Focus on ongoing quality improvement, health disparities/literacy, operational efficiency, process and tools, improved customer/healthcare professional experience and engagement.Responsible for or key team member to:
Lead launch of pilots/proof of concepts focused on improvement of health outcomes and service design enhancements including increasing the likelihood of desired outcomes [compared to a baseline] and reducing health disparities among specified populations
Research and define advanced clinical and administrative techniques associated with integrated health trends, case management and utilization management to generate new innovative solutions to advance health outcomes and affordability.
Evaluation of existing clinical programs with recommended design enhancements and quality improvements, consulting with and providing recommendations to the Product, Clinical Operations, Reimbursement and Collaborative Care team and other key stakeholders.
Actively participate in clinical design advancement with a focus on trends including health disparities and literacy.
Manage or key support for assigned current 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. (ex: Gaps in Care, Health Advocacy Programs).
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 Behavioral to ensure that we anticipate market trends and offer industry-leading products and services.
Collaborating with Informatics/Analytics and other key metrics partners to understand results - advancing the performance of our programs and services
Service utilization patterns
Clinical outcomes
High dollar claim trend patterns.
Quality outcomes
Financial results
Operational Excellence:
Understands operationally how the organization is structured, workflows and impacts of changes
Participate in development of cost savings initiatives and facilitate implementation of processes to support value across programs and bring to the market.
Partners with the technical writing team, ensuring workflows and SOP’s are aligned with regulations and system capabilities to ensure a positive customer and staff outcome/experience
Ability to present ideas and recommendation to leadership teams, often working closing with the behavioral center of excellence, in updating and providing operational support
Technical Skills
Experience owning or supporting development of Business and Technical Requirements
Ability and comfort with learning and owning components of applications
Ability to work collaboratively with key technical and non-technical matrix partners and serve as a technical liaison between business lanes
Strategic Direction and Partnerships:
Strong driver that supports the team in meeting our membership and financial targets, through the successful execution of clinical, service, and administrative results
Supports the development of other team members
Works closely with our network partners, with a focus on market gaps in contracted providers
Contributes to the enhancement and design of the clinical programs and innovations.
Qualifications
5+ years’ experience in the healthcare field; strong focus on behavioral health or EAP
Bachelor’s degree required, Master’s Degree in Business Administration, Public Health, Behavioral Health, or Business Operations Highly Preferred
2+ years of previous product development clinical design, or technical experience preferred.
Previous experience as a key team member involving complex projects, pilots or new customized solution resulting in successful execution to plans. 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.
Strong communication and presentation skills and an ability to influence at multiple organizational levels.
Innovative and open to new ideas in a focused, intense, and growth-oriented environment
Demonstrated experience in effective decision making and analytical skills
Experience managing complex projects across multiple matrix organization.
Knowledge of the healthcare industry to include an understanding of managed care, care management, disease management and health advocacy.
Demonstrated experience to work productively in a matrix management environment
Action oriented, works with a sense of urgency and takes responsibility to execute to meet aggressive timelines.
Strong interpersonal, networking and negotiations skills.
Ability to influence without authority
Experience working within an Agile Environment
Six Sigma Green Belt or Project Management Certification a plus
Other:
Ability and willingness to accommodate periodic travel
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 91,100 - 151,800 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 Evernorth Health ServicesEvernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. 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.Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.