Remote, Work from home
This position will develop and execute the Duals and DSNP (Dual Special Needs Program) product development plan across the Government Business Segment. This role is accountable for establishing and leading a multi-year, growth strategy for the Duals business across both the Medicare and Medicaid businesses. He/she will develop and execute a governance process for the business to optimize growth, profitability and regulatory compliance as well as the execution of end-to-end product development and related initiatives in preparation for 2022 product launch(es). This position serves as an integral member of the Medicare Advantage team and reports to the leader of the performance management office.
This individual will manage a matrix organization of product, population health, actuary, finance, compliance and regulatory teams to develop Duals products, enhancements, and ongoing management processes.
Key responsibilities will include:
- Establish and set direction on where the Duals product should be offered geographically, including expansion and penetration objectives development of new business models and strategic partnerships; determination of the need for specific products and services; leadership of the strategic plan in conjunction with senior level leaders; and construction of an optimal operating model.
- Own strategic responsibility for Duals product, competitively positioning the product through an understanding of the market landscape, and produce a winning product in the industry. The role will ensure financial levers and drivers are aligned to achieve optimal product results, providing customer value and affordability while meeting financial goals.
- Own the end-to-end development and implementation an effective value-based market strategy to support medical cost improvement and profitable growth, integrating inputs from product development, actuary, finance and operations, CHS local markets, clinical leadership, IT, Stars, and Risk Adjustment and other matrix partners.
- Works with Medicaid and Medicare teams to ensure program requirements are met from RFP/ application through implementation.
- Participates in the development and review of regulatory submissions (e. g., applications, bids) and beneficiary-facing materials specific to the DSNP product
- Collect and maintain data (e. g., socioeconomic, demographic, competitive) unique to dual eligibles in the market to influence product strategy and execution
- Prepare and deliver routine reports to market and corporate leadership related to DSNP product performance
- Identifies gaps and recommends enhancements related to new and/or existing products, services and workflows based on broad view of the organization; works with market, corporate, and shared services area to prioritize and implement
- Collaborates and partners with other functional managers, other business areas across/within segments or other business areas to ensure all workflow processes and interdependencies are identified and addressed.
- Maintain appropriate relationships with Centers for Medicare and Medicaid Services (CMS) to ensure compliance with guidelines and requirements and produce products to meet those parameters. Evaluates conditions to identify and implement shifts in strategic direction as needed
- Conduct financial analysis and participate in cross-development matrix teams to analyze business opportunities and address critical issues (e.g. network growth, provider termination, etc.) Also participate in the development of cross-product financial plans, business plans and strategy to support administrative, financial, and marketing objectives.
- Manage budgeting and forecasting initiatives for product lines to networks costs and provider contracts in partnership in finance. Coordinate all budget and expense management activities through effective planning, monitoring and forecasting.
- Identify opportunities for innovative products and services, network configurations, service improvements and cost savings and conducts competitive intelligence research.
- Ensure successful handover to service operations and network teams for network and product management post-implementation.
- Develop and ensure consistency with product and profitability on the future of the product. Provide leadership and a roadmap for others.
- Facilitate and ensure regular, ongoing, and effective communications among pharmacy leaders, matrix partners, key contacts across the segment and enterprise as appropriate
- Drive a "lean startup" style environment of constant experimentation and quick decision-making in alignment to strategy and organizational values.
- Shape the culture of the organization as it adjusts to an ever changing marketplace. Promote an organization that strategically builds the business and client relationships, has a long-term vision in the market, and rewards/ encourages accountability while recognizing individuality and diversity.
- Initially an individual contributor, highly-matrixed role. Must work by influence/building relationships with others. May directly manage others.
- Bachelor's degree required; Master's degree preferred
- A minimum of 15 years health care experience
- At least 10 years strong leadership and management experience in a complex organization that is positioned for growth and expansion
- Strong Medicare/Medicaid health plan experience, specifically Duals, DSNP & MMP knowledge
- A proven track record of building, motivating and driving results
- Strong financial acumen skills
- 5+ years progressively responsible leadership experience
- Strong cross-functional and indirect leader, proven ability to quickly build relationships internally and externally
- Execution focus, Strong communication & information sharing skills (oral and written), Strong financial acumen required
- Superior knowledge/experience in the Medicare industry required. Extensive knowledge of the health care marketplace, financial analysis, current reimbursement issues, budgets, and operational analysis required.
This role is Work from home (WFH) which allows most work to be performed at home. Employees must be fully vaccinated if they choose to come onsite.
This position is not eligible to be performed in Colorado.About Cigna
Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you'll enjoy meaningful career experiences that enrich people's lives. What difference will you make?
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.