Position Summary: This position is responsible for the achievement of total medical cost competitiveness; revenue and membership growth through retention of existing business and development of new customers; supporting the expansion and maintenance of high quality affordable Networks.
As Market Clinical leader, the role is responsible for driving key business and clinical initiatives in the assigned market through partnership with the market leadership GM and President, VP Network and Contracting serving as the triumvirate overseeing market strategy and performance. The role will work closely with key internal matrix partners, customers, clients, producers and Health Care Professionals in support of local market strategy. This role will work cross-functionally to identify new opportunities, and develop and implement focused strategy to ensure clinical programs deliver superior value to customers, clients and shareholders. These activities include market analysis, identification of Medical Cost improvement opportunities, competitive assessment, and innovative problem solving.
Supports growth and persistencey through strategic collaboration with Market Leaders, Sales, and Account Management to achieve Market & Segment Sales goals.
Supports market growth and account retention within the O/U 500 and Select Segments, including specialty results and penetration, by serving as the clinical expert with customers, clients and producers within the assigned market.
As the clinical expert within the market use analytics coupled with clinical expertise to drive consumer engagement and affordability to enable growth and persistency with our clients.
Responsible for the achievement of superior clinical quality and market affordability. Collaborates with Sales leadership and network partners to achieve market cost competitiveness, expense and COGs management, and earnings.
Identifies market specific total medical cost improvement opportunities, and designs and implements interventions and solutions. Collaborates with local and regional contracting and provider relations teams to optimize network performance for quality and affordability.
Direct contributor to medical action strategy planning, development and execution of local market affordability, FFV and TMC goals .
Serves as clinical representative in the network with the provider community, including collaborative and alliance partners to support successful adoption of our Connected Care strategy to drive achievement of the quadruple aim and become the Partner of Choice.
Collaborates with providers to transform healthcare delivery practices and instill pay-for-performance discipline and quality.
Acts as quality and statutory medical director for given market. Is viewed as credible clinical leader within the market by both internal and external partners.
Owns the market from a clinical perspective.
Develops and leverages strong partnerships both externally with individual vendors, providers and c-suite relationships within major facilities and internally with matrix partners in sales, underwriting, clinical operations, medical economics, network, informatics and product to achieve market targets.
Builds and maintains strong interconnectivity with the Clinical Operations and Consumer Health Engagement organizations to ensure consistent and maximized engagement in clinical programs and medical management in support of achieving market performance goals for affordability, quality and satisfaction.
Influences improvement in clinical operations processes, organizational strategy and innovation in healthcare through representing the voice of the provider through surveys, Advisory Councils and other forums to ensure bi-directional customer and provider feedback.
Supports market and regional provider contracting staff with clinical expertise for the development and execution of value-based and other contracting initiatives.
Participates, where possible, in special projects as Market Facing Clinical expert to develop strategic solutions and actions focused on key business initiatives.
Active and unrestricted Medical License in State
Current Board Certification; primary care preferred
Minimum 5 years of clinical practice experience
At least 3 years of experience in a healthcare business environment and/or Health Plan
Excellent oral and written communication skills
Well-networked and respected in medical community. Experience and success in network partnership development, practice transformation and driving practice performance,
Strong leadership, problem solving and follow-through skills; credibility with C-suite executives as well as sales and physician community.
Proven ability to function in a heavily matrixed organization
Ability to foster collaboration, value others perspectives and gain support and buy-in for organizational proposals
Ability to drive results, think strategically and implement tactically
Strong relationship building and influencing skills
Strong organizational and execution skills
Ability to convey complex information in an understandable way to various audiences
Strong analytical skills and problem solving skills
Demonstrated ability to effectively prioritize and manage multiple priorities simultaneously
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 an accommodation based on your physical or mental disability please email: SeeYourself@cigna.com. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.