RN Clinical Program Senior Advisor - Work from Home, Anywhere, USA (CPC Certification Required)

Clinical Program Senior Advisor, Institute of Clinical Oversight and Guidance (ICOG) Band: 04 Description This position includes conducting research and analysis of published medical literature to respond to internal and external inquiries, as well as the development and maintenance of Cigna Medical Coverage Policies within the ICOG unit. This position requires identification of opportunities for Clinical Policy development and ability to conduct core clinical evidence reviews through the Healthcare Medical Assessment process. This position has significant interdisciplinary policy connections; the individual in this role must be comfortable, experienced and successful working in a team culture, as well as being able to take ownership of designated clinical policies.

Responsibilities

• Develops evidence-based medical coverage policies through analytic evaluation of published medical literature.
• Coding and sourcing expert for new or revised coverage policies.
• Understands levels of evidence and can discuss the quality of a study to ensure coverage policies and medical inquiry responses transparently convey the strengths, weaknesses, and implications of published evidence.
• Presents new and revised coverage policies to a clinical audience in monthly Healthcare Medical Assessment Committee meetings.
• Effectively partners with medical policy team, manager, Medical Directors, clinical subject matter experts, and external vendors.
• Ensures that coverage policies are implemented, deployed to internet sites, and changes communicated within and outside the organization.
• Participates in special projects within the team as needed.
• Provides support as the coverage policy subject matter expert (SME) for the creation and maintenance of automation pathways.

Qualifications

• RN required. Active unrestricted license in state of residency.
• BSN preferred
• CPC Coding Certification required with a minimum of one year coding experience
• Experience with evidence-based development processes and familiarity with US governing regulatory activity related to new product approvals.
• Understanding of medical coverage policies; three years or more experience working for a health plan.
• Excellent writing, communication and presentation skills are necessary for this role.
• Must have prior experience with either clinical research or experience with writing (i.e., clinical papers, journal articles, training documents, SOP’s, technical writing, etc.).
• Ability to synthesize complex information and data into concise, understandable written responses/written responses.
• Ability to remain highly focused and organized in a fast-paced environment with frequent change and/or deadlines.

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 116,200 - 193,600 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 The Cigna Group Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. 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: [email protected] for support. Do not email [email protected] 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. Apply Job! Apply to this Job