Job Description
This is a hybrid position (3 days per week in-office + 2 days work at home). The incumbent candidate can be based out of any US Cigna Healthcare office. This position is a Hybrid role which requires office alignment but is not restricted to locations that are identified in this posting. The Quality Validation Senior Advisor will align to the of Cigna Pharmacy Business UM Operations Team and will be responsible for validating business requirements within the Medication Utilization Management applications against gathered business requirements. This role requires a keen understanding of downstream impacts and meticulous attention to detail.
RESPONSIBILITIES :
- Develop a process to validate that cross-functional business and formulary strategy requirements are accurately implemented and functioning as expected and through testing in various enterprise applications: OnePA, CSP, ATK, pharmacy and medical claims.
- Analyze and document the behaviors of applications, with a focus on downstream impacts including communications.
- Possess a working knowledge of prior authorization processes and claims adjudication and ensure end to end process is not broken.
- Collaborate with cross-functional partners to resolve complex issues.
- Document findings in a clear and relevant manner to be reviewed at leadership level.
- Other tasks as assigned.
REQUIRED EXPERIENCE/SKILLS :
- Bachelor's degree required, Master's degree preferred
- Minimum of 5 years of experience in healthcare utilization management or a related field.
- Ability to work independently and adapt quickly to changing environments.
- Comfort with complex systems and processes.
- Excellent strategic thinking and problem-solving abilities.
- Process optimization and efficiency improvement
- Strong analytical and decision-making skills
- Experience with OnePA, CSP, ATK, and medical/drug claim processing is strong plus.
- Proficiency in Microsoft Office, including Excel and Access.
- Strong organizational skills and ability to manage multiple projects.
- Ability to travel as needed up to 10%
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.
About Cigna Healthcare Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. 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.
Job Tags
Permanent employment, Local area, Work from home, 3 days per week,