Purpose of Position: The Quality Clinical Manager is an execution-focused individual who supports Evernorth Care Group (ENCG) by working closely with the Chief of Quality and Nursing to drive successful analysis, design, execution, implementation, and recommendations for initiatives related to Clinical Quality and risk mitigation.
Work hours: Monday - Friday typically 8am - 5pm (Salary position)
Summary: The Quality Clinical Manager utilizes innovative thinking about how to best assure the organization’s quality improvement program and work plans are implemented and meet NCQA requirements and is a proactive collaborator that can take a high-level project or initiative vision and strategy, as well as input from key stakeholders, and design a detailed business proposal. The Quality Clinical Manager is also detail-oriented, exhibits excellent communication skills, and is able to easily adapt to changing circumstances.
Clinical Responsibilities and Essential Functions
- Delivers expertise and leadership in the areas of Event management, Quality data and trend support, Provider peer review, and Policy and Procedure support.
- Provide oversight to Quality management for ENCG.
- In collaboration with the Chief of Quality and Nursing, support the overall ENCG Quality Management program inclusive of delegated functions, Peer Review process, Quality of Care and Adverse Event investigation and reporting, NCQA Recognition Programs, Patient Centered Medical Home quality standard implementation, state licensing quality program requirements, and process improvement activities to ensure quality patient care provided in ENCG.
- Quality Clinical Manager will work with the Quality Advisor to identify and create project deliverables to ensure successful execution of projects and initiatives that align to the business strategy, desired capabilities, and corporate mission.
- Escalate risk and needs to ensure they are addressed considered in project selection/business requirement.
- Understand the clinical technology applications and processes at a high-level to best be able to document current and future state processes, as well as identify opportunities for process improvement to meet Quality metrics.
- Collect data, document processes, perform a preliminary analysis, and propose next steps.
- Facilitate meetings, document meeting minutes and action items, and provide follow-ups as needed to ensure follow-through on action items for projects and committees.
- Write and coordinate communications for projects and initiatives.
- Analyzing and appraising management as to performance of insurance products using measurement criteria; collecting and analyzing data, identifying variance and unacceptable performance, and monitoring correction and ongoing compliance.
- Implementing quality management process policies and procedures; and managing individual case review and investigation. Utilizes in-depth professional knowledge but is guided by functional practices and well-defined management precedents.
- Focuses on implementing and executing strategies within own department/discipline/team.
- Collect data and provide analysis related to Quality measures.
- Based on a project or initiative vision and strategy, as well as input from the Clinical Team and key stakeholders, design a detailed implementation proposal.
- Engage sponsors and report outcomes and findings to Chief of Quality and Nursing, stakeholders, and sponsors.
- Identify trends and work with the Chief of Quality and Nursing to close gaps.
- Become a Subject Matter Expert to provide input and guidance in the areas of regulatory mandates, accreditation and licensing standards, and QM/QI theory.
- Participates in projects that support strategic organizational initiatives.
- Other related duties as assigned.
Minimum Qualifications:
- Bachelor’s degree in Nursing, Health Care Administration or business field of study or equivalent experience. Minimum five years of experience in healthcare. Strong leadership skills including demonstrated ability to confront resistance to change in a fast-paced highly regulated environment.
- Experience successfully evaluating and implementing quality initiatives.
- Excellent communication, leadership, and teambuilding skills. Ability to effectively present information and respond to questions from groups of managers, providers, customers, and market leadership.
- Knowledge of quality regulatory and accreditation requirements.
- Excellent computer skills, particularly related to Microsoft Word, Excel, Outlook, Visio, PowerPoint, and MS Project.
- A valid U.S. driver’s license, personal vehicle, and insurance is required.
Preferred Experience:
- 3+ years of experience as a Quality Manager or similar area of experience.
- Master’s degree in health care or business-related field desired.
- Valid certificate as a CPHQ Certified Professional in Healthcare Quality. Certification must be maintained by achievement of CEU requirements at least every three years.
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 Evernorth Health Services: Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care, and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention, and treatment of illness and disease more accessible to millions of people. 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.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
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.
The Cigna Group
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