Cigna Healthcare is hiring a Clinical Operations Director for its International Markets business. This senior leadership role reports directly to the Chief Medical Officer and is critical for blending clinical insight with operational execution to enhance healthcare delivery, cost management, provider engagement, and regulatory compliance.
What You'll Do
- Partner with the Chief Medical Officer to shape and advance clinical strategy across areas like value-based care, cost of care, patient/provider experience, and population health.
- Lead affordability planning, reviewing trends and required actions for further enhancements.
- Direct daily operations of clinical programs, ensure SLA adherence, and manage team performance against volume forecasts.
- Drive and be accountable for the execution of the Clinical operating plan, roadmap, project efforts, and major initiatives for US incurred Claims/Services.
- Lead a matrixed environment of internal clinical and operations staff.
- Use data-driven approaches and tools to optimize workflows, track KPI performance, and drive continuous improvement and affordability initiatives in partnership with network and PI teams.
- Analyze affordability outcomes, recognize and prioritize opportunities for improvement, and inform actions based on clinical and business trends.
- Ensure clinical processes align with regulatory policy and quality requirements and identify and mitigate operational risks.
- Lead governance around clinical programs and create and deliver executive updates, business reviews, and internal/external communications.
- Serve as a critical business partner, working closely with the Clinical Solutions team, EviCore, Cigna Behavioral Health team, US Employer clinical team, and key matrix partners.
- Partner closely with the XT team to represent International on key initiatives around prior-authorization and Cigna clinical policies & medical cost containment.
- Give clinical evidence-based advice on medical claims, considering internationally accepted protocols and local and/or regional customs and regulations.
- Actively monitor new and emerging clinical trends, practices, and solutions and assess their applicability to key business initiatives and strategies.
- Ensure attainment of quality, production, timeliness, cost containment goals, and excellent customer satisfaction for both internal and external customers and clients.
- Drive reporting improvements with Medical Economics, Finance, and Data and Analytics for Commercial team use and be proficient in explaining and consulting.
What We're Looking For
- Current/recent leadership experience and the ability to drive results in a highly matrixed organization.
- A working understanding of and experience with operational reports and metric data, and comprehension of how to communicate that data to senior leaders and team members.
Nice to Have
- Prior experience in a clinical organization.
- Doctorate Degree in Medicine (MD or DO).
Team & Environment
You will be a member of the Clinical Leadership team, leading a matrixed environment and reporting directly to the Chief Medical Officer for Cigna Healthcare - International Markets.
Benefits & Compensation
- Annual compensation range: $230,600 - $384,400 USD.
- Comprehensive health-related benefits including medical, vision, dental, and well-being and behavioral health programs starting day one.
- 401(k) with company match.
- Company-paid life insurance.
- Tuition reimbursement.
- A minimum of 18 days of paid time off per year plus paid holidays.
- Eligibility to participate in an annual bonus and long-term incentive plan.
Work Mode
This position is hybrid.
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.
