**Key Responsibilities:**

+ Project Management focused on strategically designed initiatives, supporting the full project scope and assessment to identify Health Management impacts end to end including the identification of any gaps, barriers and other issues that may result in overall outcomes of the projects utilizing 278 EDI logic.

+ Expectations include: design, development and management of the project workstream that encompasses the EDI needed to meet and exceed overall Health Improvement goals, including but not limited to: Clinical value metrics to achieve Total Medical Cost savings targets, implement pilots/projects, improve/ensure Quality improvement, operational efficiency, and effectiveness via utilization of appropriate project management processes and tools: all of which result in measurable improvement in overall customer health care, professional experience, customer engagement and client partner satisfaction with delivery of the services purchased.

+ Support and manage and assessment of all assigned key components of a project that utilized 278 EDI logic and in the support of development, evaluation and implementation of new or changing health improvement products, programs, business systems, service delivery models and tools.

+ Support the enhancement & development of operational workflows changes for all Health Management projects with program impacts including UM, CM, Intake and working with those matrix partners and dependencies.

+ Demonstrate the ability to manage multiple complex time sensitive initiatives with numerous internal partners designed to deliver targeted outcomes and health improvements (Enterprise, Multi-vertical)

+ Define and advise on all business and system requirements for assigned projects from an end-to-end perspective.

+ Lead implementation via successful project management of changes within Health Management (organizational transitions, etc.) partnering with appropriate vertical SME and/or PM and eviCore teams.

+ Ability to work in partnership with Product, Quality, Program Development, Compliance, eviCore, Gateway, IBOR, IT, R&S, Pharmacy teams as well as all Operational SME’s for each impacted area.

+ Effectively manage daily data and proactive assessment of identified trends/issues and gaps.

+ Effectively communicate data outcomes to the appropriate business owner with details/requirements and identify areas of business impacted.

+ Defines the requirements for needed system modifications and give relative and timely input regarding the prioritization of requests for assigned business areas and projects.

+ Collaborates and aligns with Product, Clinical Operations, Service Operations, Pharmacy, Claims, Analytics, Network, IT and many other key matrix partners.

+ Manage scenario and testing results related to 278 EDI.

+ Post implementation of processes utilizing EDI transmissions with responsibilities to identify trends/gaps/outcomes.

**Qualifications & Role Requirements:**

+ Minimum of 5 years’ experience in healthcare or clinical operations with key leadership responsibilities involving complex projects across multiple matrix organization

+ Experience as a team leader or key team member involving complex projects, pilots or new customized solutions resulting in successful execution to plans.

+ Current or previous Project Management/Six Sigma experience with demonstrated proven ability to successfully execute complex projects is preferred.

+ Innovative and open to innovative ideas in a focused, intense, and changing growth-oriented environment

+ Ability to work in a fast paced, demanding and rapidly changing environment.

+ Strong analytical thinking and able to generate ideas from industry studies, reports, research and able to support root cause analysis to generate new innovative ideas and concepts.

+ Deep knowledge of Cigna products and services, including expert knowledge of clinical programs and strategies

+ Demonstrated experience and exceptional ability to work productively & independently within a highly matrixed management environment across geography, departments, and position levels.

+ Ability to lead and influence in a matrixed environment is critical.

+ Ability to negotiate with peers and senior leaders to achieve productive solutions to business problems.

+ Action oriented, works with a sense of urgency and takes responsibility to execute to meet aggressive timelines.

+ Effective communication and presentation skills and an ability to influence change at multiple organizational levels.

+ Demonstrated interpersonal, networking and negotiations skills, strong motivator, and team player with the ability to lead and delegate responsibilities as needed.

+ Extensive knowledge of eviCore integration.

+ Knowledge of EDI (278/275) values, processing, mapping, and business use.

+ Travel requirement 10-20%

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.

For this position, we anticipate offering an annual salary of 113,600 - 189,300 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group .

**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._

_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._

_Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances._