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The Business Analytics Director of Healthcare Utilization Management position is an opportunity for a proven leader who can create the roadmap and vision for the Utilization Management team and its outcomes. These outcomes will be used to inform how to constantly improve continuum of care between our physician partners and customers as they navigate the delivery system.
Reporting to the Head of Customer and Clinical Data and Analytics, this role will work collaboratively with our Chief Medical Officer and clinicians, as well as Global & Data Analytics partners.
Provide thought leadership in supporting and driving medical outcomes for the organization, identifying and prioritizing opportunities for impact, developing solutions aimed at improving the health of our customers, and leveraging data science and technology capabilities to do so.
Strategize and develop an integrated roadmap with the utilization management team that aligns key data & analytic capabilities within the medical policy approval space.
Identify opportunities for more efficient pre-certification decision-making by deploying advanced analytics within operational approval processes.
Build and grow a Business Analytics team that executes a suite of analytic methods (e.g. opportunity analytics, econometric modeling, casual inference) to answer key business questions or enable a set of business actions.
Partner to deliver an expanded set of data science and reporting methods by working with Central Informatics Partners
Note: **The ideal candidate will have deep medical policy experience, claims adjudication experience with an understanding of clinical guideline care. Medicare and fraud expertise is also ideal.
Minimum of a Master’s degree in a quantitative field such as Statistics, Biostatistics, Econometrics, Economics, Actuarial Science, Data Science or equivalent work experience
Minimum 10 years’ industry experience solving business problems through the application of analytic approaches
Must have experience leveraging health outcomes research to inform credentialing and value-based contracting.
Extensive experience mining authorization and medical management data for process improvement opportunities and customer outcomes
Subject matter expertise in consumer (e.g. eligibility, digital, socio-demographic) and managed care clinical data (e.g. claims, labs, Rx).
Demonstrated thought leadership on challenging problems with examples of implementing innovative analytic solutions and driving outstanding results
Proven ability to work collaboratively in complex matrix organizations and agile teams
Experience blending creativity, relentless problem-solving, business acumen, and leadership to drive innovation through analytics working with an Innovation team
Strong verbal/written communication and leadership skills to work with various matrix partners, including but not limited to actuarial, medical economics, business, marketing, and IT/IM.
Ability to manage a vision and purpose with various business stakeholders and analytics teams.
Relevant company experience: e.g., CMS – Centers of Medicare/Medicaid Services, QPid, Arcadia, Rand Institute.
Qualified applicants will be considered without regard to race, color, age, disability, sex (including pregnancy), childbirth 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 an accommodation based on your physical or mental disability please email: SeeYourself@cigna.com. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.