Job Description

Position Scope

The purpose of this position is to support the Quality Management Program through multiple clinical, service and operational activities by driving continuous quality improvement in patient safety and improvements in efficiency and effectiveness; and by supporting activities to measure clinical programs and service processes and outcomes.

This position is a Cigna Work at Home and requires minimal domestic travel of up to 5% for internal meetings, accreditation or quality components of state regulatory audits related to customer experience. This position reports to the Quality Clinical Management Manager.

Major Responsibilities

• Reviews, investigates and monitors assigned clinical and quality activities such as Quality of Care Complaints and Adverse Events, which may include follow up with
• internal medical executives/directors, external health care professionals/facilities, and individual customers as well as presentation to the Peer Review Committees (in
• accordance with National Policies and Procedures).
• Implements partnerships and participates in initiatives focusing on reducing health disparities.
• Collects and analyzes data, develops studies and reports to workgroups and supports quality committee activities.
• Performs review of clinical metrics and data and monitors for patient safety including continuity and coordination of care.
• Supports provider performance measurement activities such as generating and reviewing reports and medical record reviews.
• Define and document policies, standard operating procedures, workflows and processes.
• Participates and leads special workgroups and process improvement teams as needed.
• Supports regulatory compliance activities as needed.
• Outcomes Expected
• Resolve Quality of Care and Adverse Event cases and send resolution letters within required timeframes 95% of the time.
• 100% of QM Work plan activities, and policies and procedures will be completed as scheduled and meet accreditation requirements.
• Assess/measure performance, conduct oversight and drive improvements in care/patient safety and service.
• Demonstration of skilled use of the following competencies:
• Customer Focus
• Learning and Applying Quickly
• Problem Solving

Minimum Requirements

• Bachelor’s degree preferred
• RN or LPN
• Three to five years of quality review and improvement experience preferred.
• Managed care or other health and service care delivery service related experience
• Preferred Requirements
• Experience with NCQA and/or other accreditation standards, quality management preferred, but not required.
• Strong oral and written communication skills
• Excellent time management, project management, organizational, research, analytical, communication and interpersonal skills

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 75,000 - 125,000 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 The Cigna Group

Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. 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.

Job Tags

Local area, Work from home,

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