What are the responsibilities and job description for the Utilization Management & EMR Product Lead position at The Cigna Group?
US Employer – Affordability Governance & Execution
Network Strategy & Solutions – UM and EMR Product Lead
As part of the Network Strategy & Solutions leadership team, this role will be responsible for the redesign of our Prior Authorization, Utilization Management (UM), and Electronic Medical Record (EMR) solutions. This leader will work with matrix partners in the Clinical organization to evolve our UM programs and management processes. This role also has accountability for the financial performance of our UM programs, which will require a balancing of benefits (e.g. Affordability and clinical outcomes) vs. cost (e.g. OPEX, client/customer abrasion, etc.). The execution of the newly established strategy will require close partnership with the product and pricing teams to determine go to market implications.
This role will also be responsible for our EMR roadmap, investment, delivery, and provider recruitment. The individual will be responsible for working directly with providers to establish EMR connectivity across numerous use cases, including UM. The role will build out a multi-year roadmap and investment choices with the expectation of growing connections with EPIC as well as other EMRs. Tied directly to EMR integration, the individual will establish our gold carding strategy, which will include identification, monitoring, incentives, etc. to ensure we are maximizing outcomes for our clients and customers.
Primary Responsibilities Include
For this position, we anticipate offering an annual salary of 177,400 - 295,600 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 and long term incentive 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.
Network Strategy & Solutions – UM and EMR Product Lead
As part of the Network Strategy & Solutions leadership team, this role will be responsible for the redesign of our Prior Authorization, Utilization Management (UM), and Electronic Medical Record (EMR) solutions. This leader will work with matrix partners in the Clinical organization to evolve our UM programs and management processes. This role also has accountability for the financial performance of our UM programs, which will require a balancing of benefits (e.g. Affordability and clinical outcomes) vs. cost (e.g. OPEX, client/customer abrasion, etc.). The execution of the newly established strategy will require close partnership with the product and pricing teams to determine go to market implications.
This role will also be responsible for our EMR roadmap, investment, delivery, and provider recruitment. The individual will be responsible for working directly with providers to establish EMR connectivity across numerous use cases, including UM. The role will build out a multi-year roadmap and investment choices with the expectation of growing connections with EPIC as well as other EMRs. Tied directly to EMR integration, the individual will establish our gold carding strategy, which will include identification, monitoring, incentives, etc. to ensure we are maximizing outcomes for our clients and customers.
Primary Responsibilities Include
- Accountable business leader for driving financial outcomes of our Utilization Management programs and EMR investments
- Works in tandem with the clinical organization to ensure our programs are improving clinical outcomes and can be measured and articulated to clients/brokers.
- Responsible for developing our gold carding strategy, from identification to implementation to monitoring.
- Responsible for partnering closely with our product organization to ensure the UM roadmap is aligned and linked to our product roadmap (e.g. can we gold card Pathwell Bone and Joint providers)
- Establish a provider recruitment and relationship management team that focuses on EMR connectivity to create mutual value for the firm and the provider.
- Interface with all provider facing teams (contracting, provider relations, market med execs) to ensure we are effectively communicating and implementing our UM/EMR strategies.
- Oversees capability and solutions architecture. Partner closely with the operations and technology functions to ensure proper solution execution and management.
- Responsible for establishing the business case for incremental investment and work closely with the TCC measurement office to validate those business cases.
- Responsible for directing various analytics resources across MEU and Data Science in support of our programs.
- Responsible for representing the health of our UM/EMR programs to segment and executive leadership.
- Reports to VP Network Strategy & Solutions, with joint accountability to optimize value to our clients, customers, and providers.
- Lead and influence through a matrixed enterprise environment
- Build a high performing culture by continuously working with matrix partners to add, develop and upgrade talent.
- Develop strong talent pipeline and ensure effective succession planning is in place.
- Drive best practices across markets as it relates to total medical cost value proposition.
- Ability to make decisions and take calculated risks without full information.
- Exceptional communication and influencing skills to drive internal and external alignment.
- Ensure appropriate structure / governance is in place to deliver on goals.
- Build relationships with business leaders across functions and ensure functional / support teams are engaged as needed to support business strategy and execution priorities.
- 10 years of healthcare management experience with a successful track record of developing and leading teams / organizations in a similar capacity
- Expert level knowledge of network design, physician partnership, analytics, and product
- Strong working knowledge of how High Performing Providers can lead to differentiated pricing, service, benefits, or any other activities that benefit our clients and customers.
- Hybrid- 3 days a week in office
For this position, we anticipate offering an annual salary of 177,400 - 295,600 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 and long term incentive 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.
