Quality Data Quality and Informatics Director - Work Anywhere, USA-Hybrid. (RN Preferred)

Clinical Program Director

The Clinical Program Director sets clinical strategy to drive improvements in health, patient experience, and health disparities. This position will create a high performing team who will be deployed to plan and execute innovative solutions to tackle significant clinical challenges impacting health, total cost of care, patient experience, health equity, and other opportunities. This role involves strategic planning, implementation, and evaluation of health improvement initiatives with a strong focus on generating quantifiable results. The ideal candidate will possess strong leadership skills, clinical expertise, and a commitment to advancing patient care.

Specific responsibilities include but are not limited to : analyzing and appraising management as to performance of insurance products using measurement criteria; collecting and analyzing data, identifying variance and unacceptable performance, and working across the enterprise to establish innovative solutions to drive results. Utilizes in-depth professional knowledge and experience to set priorities. Focuses on achievement of enterprise, segment, and local goals and plays a significant role in communicating results, value, and learnings from initiatives.

Enterprise Quality & Accreditation is seeking a dynamic, highly motivated, strategic, and results oriented leader to manage and lead a team of individuals responsible for designing, executing, and evaluating clinical initiatives to drive improved health outcomes. This leader sets clinical strategy and works with the team to create new and compelling clinical initiatives to improve health and assure Cigna's competitive positioning in the marketplace.

This role drives continuous improvement of clinical measures through partnership with matrix leaders in multiple clinical areas of the organization including but not limited to : Clinical Operations, Contracting, Data Interoperability, IT, Digital Solutions, Legal / Compliance, Care Solutions, Accreditation Programs, and the US Commercial Quality Organization. This role will additionally partner with external partners to support specific pilots and initiatives. Must be adept at leveraging technology and multiple modalities to drive operational and clinical improvements while managing program expenses, through strategies including : vendor re-negotiation, new technology support and outsourcing. Must maintain current view of competitive landscape and drive modern approaches to impact behavior change. Drives ongoing improvement in results while meeting the demands of a dynamic and changing industry, and supports future growth as the organization advances towards Cigna's Drive to 2025 goals. Supports Cigna's continued success as a Global HealthCare Company by assuring that results align with Cigna's mission.

Program Development and Implementation : Design, develop, and implement innovative clinical programs aimed at improving patient health outcomes and addressing clinical gaps.

Strategic Planning : Collaborate with senior leadership to develop strategic plans for program growth and effectiveness, aligning with organizational goals and priorities.

Data Analysis and Evaluation : Utilize data analytics to assess program effectiveness, identify areas for improvement, and ensure evidence-based practices are applied.

Team Leadership : Lead, mentor, and manage multidisciplinary teams involved in program execution, ensuring alignment with clinical objectives and standards.

Stakeholder Engagement : Work closely with healthcare providers, patients, and other stakeholders to foster collaboration and support for program initiatives.

Compliance and Quality Assurance : Ensure programs comply with regulatory requirements, privacy standards, and organizational policies. Implement quality assurance measures to maintain high standards of care.

Budget Management : Set and manage program budgets, allocate resources efficiently, and ensure financial sustainability of program initiatives.

Continuous Improvement : Stay abreast of industry trends, emerging practices, and advancements in healthcare to continuously enhance program effectiveness and patient outcomes.

Strategy : Sets strategy and priorities for the deployment of staff to establish national, market-level and measure specific clinical quality and patient experience initiatives for the enterprise.

Design & Execution : Oversees the design and implementation of clinical quality initiatives, studies, and pilots to improve HEDIS results, patient experience, enterprise quality opportunities. Analyzes results and develops annual strategy and plan to address high impact and clinically meaningful opportunities.

Innovation : Ability to lead innovation strategically by identifying value opportunities and partnering with matrix operational, clinical, and technology teams to implement and achieve value

Team Development : Builds, develops and inspires a positive and high performing team and culture :

• Creates a sense of purpose / meaning for the team that aligns with Cigna's value and mission.
• Supports and promotes appropriate team alignment and process improvement work.
• Provides coaching and development to teams, in particular, direct reports for succession planning and overall career growth.
• Fosters an effective work environment and ensures employees receive appropriate communication, recognition and development.
• Creates, leads, and directs a culture of innovation with the application of human-centered design tools, techniques, and methods. Ensures timely voice of the customer is solicited to identify the unique needs of customers in key geographies. Facilitates multi-disciplinary workshops and ideation sessions. Brings emerging concepts to life through prototyping to communicate ideas in compelling ways to test initiatives and understand how the end user will respond.

Partnership : Matrix partnership will be key to success in this role as priorities will likely scan multiple teams and be enabled in strong partnership with many areas across the enterprise including but not limited to : Care Solutions, Digital IT, Automation, Data Interoperability, provider contracting, market facing support, etc.

Segment Support : While the role has an enterprise scope, the role provides ongoing support to the Individual Family Product segment and US Employer segment through clinical initiatives designed to optimize the HEDIS and Quality Star Ratings (QRS). Encourages participation of matrix partners in regional quality analysis and planning, resulting in improved coordination of activities across the organization.

Process Management : Directs consistency of process application across all market aligned teams while allowing for variation to best support the unique needs of the local market population. Directs budgeting and assures that funding and resources are optimized

Directs Project Leadership : Serve as point of contact for potential incoming projects specific to clinical quality improvement that will impact resources; work with appropriate matrix partners to determine net business impact of project deliverables and identify / deploy appropriate subject matter expertise.

Training and Coaching : Leads the Clinical Quality Senior Advisors and functions; Leads the broader team in alignment with CP&Q's talent priorities. Assures training material and standard operating procedures are easy to understand; provide formal feedback loop to support staff development, e.g., coaching, trends, learning sessions, etc.

Management : Directs all operations relative to Clinical Quality Improvement to assure that Cigna operates in an environment of continuous improvement.

Communication : Prepares and presents as needed the results of key prioritized initiatives to department, leadership, matrix partners, and externally as needed.

Ideal Candidates will offer the following :

Qualifications