Coverage Review Operations provides a variety of clinical services that health plans and pharmacy benefit managers utilize to safeguard patient health and safety and improve affordability while reducing unnecessary costs. The Vice President of Coverage Review Operations oversees the functions of pharmacy utilization management, medical drug management and direct member reimbursement. The successful leader will build on and execute a strategic vision which balances clinical integrity, regulatory compliance, operational efficiency and technology and process innovation. Within a 24/7/365 operation, this role will lead an expansive team consisting of 1500+ clinical and non-clinical employee team members, with additional onshore and offshore supplier partner resources.
The VP Coverage Review Operations will report directly to the Senior VP of Customer Experience and Operations Enablement and work closely with a broad network of internal and external partners and stakeholders. This leader will need a strong understanding of healthcare utilization management and the pharmacy benefit management landscape as well as the ability to envision how technological innovation will shape the industry going forward. A strong process improvement mindset, and the ability to quickly assess opportunities and prioritize areas for improvement are key for success. The ability to influence and form strong cross-functional partnerships is required to succeed in our highly matrixed organization. Demonstrated superior capabilities in leadership and employee engagement are vital in driving a culture of enablement, growth and recognition.
Responsibilities:
Utilize experience and expertise in operational strategy to champion and build upon the vision and strategy for Coverage Review Operations
Provide strategic thought leadership and drive bold change and continuous improvement to advance provider and member experiences/ partnerships, leading to reduced expense and increased customer satisfaction
Lead team in the execution and iteration of its multi-year people, process, and technology roadmap
Work cross functionally with multiple Product Management organizations, Clinical Oversight and Technology to provide seamless operations delivery while delivering innovative, new to market benefit products.
Partner closely with Quality Management & Accreditations, Regulatory Compliance, Legal and other internal and external partners to ensure operation meets and maintains all regulatory and accreditation requirements
Partner with Technology & Product organizations to innovate, pilot and scale technology and process solutions including automation, data integration, and GenAI
Lead, engage and motive a diverse team, both clinical and non-clinical, across a large geographic footprint
Inform Coverage Review Operations vendor strategy, investment and engagement for desired outcomes
Oversee the service delivery of a global service partner network and identify expansion opportunities
Drive engagement and accountability with global service partner senior executives
Manage operating expenses and evaluate competing priorities to ensure coverage of the most critical business opportunities
Coach and develop team in their individual development needs to create a strong leadership pipeline
Role Competencies
Managing Vision and Purpose-Communicates a compelling and inspired vision or sense of core purpose; Can inspire and motivate entire units or organizations; is Optimistic; Creates mileposts and symbols to rally support behind the vision
Strategic Agility- Is able to come up with the next great breakthrough things to do; is creative, a visionary, and can manage innovation; is an effective strategist full of ideas and possibilities; sees multiple futures; has broad interests and knowledge; can both create and bring exciting ideas to market; comfortable speculating about alternative futures without all of the data
Influential Leadership- Is skilled at getting individuals, teams, and an entire organization to perform at a higher level and to embrace change; negotiates skillfully to achieve a fair outcome or promote a common cause; communicates a compelling vision and is committed to what needs to be done; inspires others; builds motivated, high-performing teams; understands what motivates different people
Customer Centricity-Listens closely with empathy to the needs and experiences of customers and clients; responds to concerns with a sense of urgency; designs solutions with the end-user in mind
Operational Execution-Identifies the necessary actions and initiatives to effectively execute on the local market strategy
Matrix Leadership-Has a strong network; convenes and orchestrates stakeholders; effectively influences others through collaboration; and has the flexibility to lead from the "front" and "back" of the room
Professional Savvy- Can maneuver through complex political situations effectively and quietly; is sensitive to how people and organizations function; anticipates where the land mines are and plans his/her approach accordingly; views corporate politics as a necessary part of organizational life and works to adjust to that reality
Innovation-Supports bringing creative ideas to the market; invests time and resources to evolve products; rewards successful unique solutions
Business Acumen- Knows how businesses work; knowledgeable in current and possible future policies, practices, trends, technology, and information affecting his/her business and organization; deep knowledge of existing and emerging competition; is aware of how strategies and tactics work in the marketplace
Assessing Talent- Ensures leaders recognize the development of internal talent is a priority; identifies succession candidates for key positions; shapes roles and assignments that leverage and develop people's capabilities
Change Leadership- Builds an agile organization that is able and willing to adapt to changing requirements; clearly communicates the need, rationale and impact of the change; can see opportunities for synergy and integration where others can't; knows how to organize people and activities
Motivating Others- Creates a climate in which people want to do their best; can motivate many kinds of direct reports and team or project members; can assess each person's hot button and use it to get the best out of him/her; pushes tasks and decisions down; empowers others; invites input from each person and shares ownership and visibility; makes each individual feel his/her work is important; is someone people like working for and with.
Qualifications:
Bachelor's Degree or equivalent work experience
8+ years of healthcare industry related experience; minimum of 5 years of operations management experience required
Excellent knowledge of developing and executing core operations functions and strategies
Excellent negotiation and influencing skills, including public speaking and presentation skills
Effectiveness leading in highly matrixed organization with process management capabilities
Experience leading a large team overseeing broad scale operations with strong cross functional partnerships (Global Service Partners, BPOs, Human Resources, Workforce Management, Account Management, Technology, etc.)
Comfortable dealing with and managing an ever-changing environment; communicates optimism and confidence in the future
Strong business and financial acumen
A passion for employee engagement and leadership development
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 238,600 - 357,800 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 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 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: 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.
