ROLE SUMMARY

The Senior Manager of Quality, Coaching, and Audit Programs will develop and execute a comprehensive operational quality and coaching program for non-clinical and clinical behavioral health staff. This program is crucial for maintaining and enhancing service quality and ensuring compliance with industry regulations. This role will oversee onshore clinical and non-clinical quality teams as well as develop, execute and maintain an offshore quality support structure in collaboration with offshore resource teams.  In addition to operational quality, this role is responsible for oversight of the Behavioral external audit team, collaborating with Medical External Audit team and external consultants to support our Cigna/Evernorth External Audit process. 

MAJOR DUTIES

Evaluate current state Operational Quality & Coaching Program; develop/enhance and execute a comprehensive operational quality and coaching program for non-clinical and clinical behavioral health staff.

Develop, execute and maintain an offshore quality strategy to supplement onshore activities that allows our organization to utilize resources in the most effective and efficient manner in support of the overall Quality & Coaching Program.

Ensure all quality processes/procedures support and are aligned to business expectations, process, policy/procedure and accreditation standards. Maintain regular connection and collaboration with business leaders and key stakeholders to ensure clarity and alignment on quality standards.

Maintain consistency across both onshore and offshore teams ensuring that their work aligns with program goals and objectives. This will involve regular training and feedback sessions (IRR) to uphold consistency, high performance and adherence to best practices.

This role leads Supervisors and/or managers of clinical quality, non-clinical quality and Behavioral External Audit teams.  The Sr. Manager is expected to lead effective teams, with demonstrated leadership skills that provide direct reports with clear expectations, to drive positive team culture and results for the organization.

 Ensure a quality reporting structure is in place with regular program performance metrics outlined at the individual, team, and organizational level for aligned business areas and key stakeholders. 

Regularly analyze program performance metrics and data to identify opportunities for enhancement and optimization. Regularly reporting your findings and recommendations to senior management to drive continuous quality improvement.

QUALIFICATIONS

Bachelor’s degree in a related field; Master’s degree preferred.  Ideally in business or healthcare related field of study.

8+ years of progressive experience in quality management, audit, or coaching, focusing on behavioral health or healthcare/managed care environments.

Proven experience managing and leading teams, including remote or/or offshore team members.

Knowledge of industry regulations, accreditation standards (ex. NCQA, URAC) and quality improvement methodologies.

American Society of Quality (ASQ) Quality Manager Certification and/or Certified Professional in Healthcare Quality (CPHQ) required or ability to obtain within a year of hire.

Strong understanding of non-clinical and clinical staff roles and responsibilities within the behavioral health industry.

Excellent communication, interpersonal, and problem-solving skills.

Highly Skilled in Matrix Partner Collaboration

Proven ability to learn new systems, technologies and processes quickly and efficiently

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 123,000 - 205,000 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.