Cigna Clinical Program Manager-Philadelphia, PA OR Baltimore, MD! in Philadelphia, Pennsylvania

It's fun to work in a company where people truly BELIEVE in what they are doing!

We're committed to bringing passion and customer focus to the business.

Provides strategic planning, decision making, and direction of a quality, cost effective delivery system providing health services to members. Manages inpatient and outpatient medical costs at levels consistent with the plan's objectives by directing the case management, medical review, utilization review, quality assurance/improvement, and/or health education programs.

Required Skills:

Responsible for assisting in the development, implementation and management of health services functions and in achieving department goals and objectives. Provides guidance and supervision to clinical and non-clinical staff that are field and office based. Responsible for process improvement implementation, quality initiatives, and daily operations of the department. Applies knowledge of utilization review and case management activities. Responsible for process improvement implementation, quality initiatives, and daily operations of the department. Performs updates to policies and procedures that are compliant with CMS requirements and NCQA/URAC/CMSA requirements. May audit and must comply with corporate, federal, and state policies, procedures, and confidentiality standards. Conducts analysis on department statistics and creates reports on the findings. May act as a liaison with internal departments, outside entities, including physicians, hospitals, health care vendors, social service agencies, member advocates, and regulatory agencies. Leads departmental meetings and cross departmental project teams. Coordinates coverage and cross training of functions. Serves as a subject matter expert and leads process improvement teams in the review and analyzing of process functions and implementing changes. Analyzes departmental data and participates in appropriate forums for sharing this data and leading initiatives relating improvements. Performs all HR related functions including time management, expense management, and performance management including those related to lower level managers. Provides departmental coverage in the absence of higher level managers.

Minimum Requirements:

Bachelor’s degree preferred; Master’s degree strongly preferred

Active and unrestricted RN license preferred

3+ years’ demonstrated effectiveness managing managers/leaders including HR responsibilities

9+ years’ work experience in a clinical setting preferred

Case Management or P4Q knowledge

Proven experience to continue to drive change in a highly changing and government regulated healthcare environment

Ability to motivate others

Strong and effective communication skills required

Advanced knowledge and working experience using Microsoft Office Programs

Ability to travel: 15%

Qualified applicants will be considered for employment without regard to age, race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status.

If you require an accommodation based on your physical or mental disability please email: Do not email for an update on your application or to provide your resume as you will not receive a response.

We’re a global health service company dedicated to helping people improve their health, well-being and sense of security. We offer an integrated suite of health services, such as medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products that serve over 95 million customers around the world. When you work with us, you’ll enjoy a different kind of career - you’ll make a difference, learn a ton, and change the way people think about health insurance. To see our culture in action, search #TeamCigna on Twitter or Instagram.