Medicare Prospective Program Director

The Prospective Program Director will report to the Risk Adjustment Strategy Lead (Senior Director) and will be responsible for Cigna Medicare’s Risk Adjustment & Stars Prospective Program performance.  

The Director will maintain a matrix orientated relationship with other key functional areas that contribute to driving risk adjustment accuracy and completeness, including coding, compliance, and submission teams as well as provider engagement and education teams.  The ideal candidate will have strong risk adjustment & Stars program and operations experience with a continuous improvement mindset, data-driven approach, and a proven track record of delivering results in a matrix orientated environment. The candidate will also have experience integrating risk adjustment and Stars programs.

Responsibilities

• Monitor performance of vendor and internal In Office Assessment programs
• Monitor performance of In Home Assessment vendors
• Coordinate movement of members from In Office to In Home programs
• Design and implement market and provider level customized interventions to improve provider engagement and program participation
• Design and implement member level outreach for yearly health checkups and coordinate with Customer Incentive Program team
• Improve provider education process and materials
• Drive integration of Risk Adjustment and Quality prospective programs and teams
• Identify trends in key operational metrics and inform financial projections specific to prospective risk adjustment programs
• Prepare and present executive level reviews of prospective program performance
• Coordinate best practices across MA and ACA (IFP)
• Assist in the redesign of In Office and In Home Assessment programs
• Understand and implement business controls and reporting across markets and enterprise functional units to ensure that there is clear continuous improvement towards risk adjustment goals over time

EMR Integration Lead for Risk Adjustment

• Coordinate integration with CareAllies provider portal for In Office Assessment completion and direct EMR connections
• Redesign Cigna MA In Office Assessment EMR integration program and coordinate with vendor In Office Assessment program EMR integration modality
• Participate in Cigna enterprise level EMR Integration/Interoperability Center of Excellence

Qualifications

• Bachelor’s degree highly preferred, Masters preferred or equivalent experience
• At least 8 years of prospective program management and provider engagement experience needed, with at least 4 years in a healthcare senior leadership role
• Expert level experience with Risk Adjustment and Stars programs and operations required.
• Clinical experience helpful- Nursing background a plus.
• Business Acumen: Deep understanding of Medicare Advantage Risk Adjustment, Provider Engagement and Education, and Compliance
• Track record of managing and leading teams focused on improvement, insights, strategy and execution
• Demonstrated ability to execute complex projects and operational processes in a matrixed environment

This position is not eligible to be performed in Colorado.

About Cigna

Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you’ll enjoy meaningful career experiences that enrich people’s lives. What difference will you make?

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.