(RN) Clinical Program Senior Advisor, Cigna Coverage Policy Unit - ENCORE at Cigna in Bloomfield, Connecticut

Job Description:

Description

This position includes responsibility for conducting research and analysis of published medical literature in order to respond to internal and external inquiries and the development of Cigna Medical Coverage Policies. This includes identification of opportunities for CP development and core clinical evidence review through the Medical Technology Assessment process. The role supports all product lines of business-Employer Group, Individual, Medicare, Disability, Cigna Global., SAR, Payer Solutions, and QualCare. This position has significant interdisciplinary policy connections; the individual in this role must be comfortable, experienced and successful working in a team culture.

Responsibilities

• Develops evidence-based medical coverage policies (CPs) through analytic evaluation of published medical literature.


• Understands levels of evidence and is able to discuss the quality of a study to ensure coverage policies and medical inquiry responses transparently convey the strengths, weaknesses, and implications of published evidence.


• Analyzes data to identify utilization trends, ensure maximum policy implementation, and to identify potential total medical cost (TMC) opportunities


• Presents proposals to the TMC committee for consideration; once a project is recommended to move forward, acts as a critical member of the project team to bring the initiative through the governance process and implementation


• Engages with the Precertification Committee to evaluate adding/removing codes from precert based on assessment of utilization trends and ROI


• Provides clinical expertise as a voting member in the NAU second level appeals calls


• Participates in National Clinical Updates and Pearls (CUPS) Calls, with UM RNs and Medical Directors, responding to questions and providing clarification on new and revised Coverage Policies.


• Effectively partners with Coverage Policy Unit (CPU) medical policy team, manager, CPU Medical Director, clinical subject matter experts, and external vendors to meet business needs and strategic goals


• Presents new and revised coverage policies in monthly Medical Technology Assessment Committee meetings in a concise, articulate manner, demonstrating a thorough understanding of the topic and key issues.


• Works with other team members to ensure that coverage policies are implemented, deployed to internet sites, and changes communicated within and outside the organization.


• Participates in projects within the Coverage Policy Unit as needed

Qualifications

• RN, BSN degree or equivalent


• Experience with evidence development processes and familiarity with US governing regulatory activity related to new product approvals


• Experience with coverage policy; five years managed care experience preferred


• Strong analytic skills and experience using data to drive decision making


• Project management experience a plus


• change Excellent written and verbal communication skills


• Ability to synthesize complex information into concise, understandable written responses/positions


• Flexibility. organizational agility


• Ability to maintain focused, calm and positive in a fast-paced environment with frequent

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.

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.