- Participate in portfolio project discussions about HEDIS and serve as a subject matter expert.
- Thinking analytically and strategically as you look for ways technology can help support new business opportunities or create efficiencies in processes that support HEDIS.
- Work closely with senior business and technology leadership, technology teams, and cross-functional stakeholders to ensure technology alignment with business goals and identify opportunities for innovation.
- Support the HEDIS product development process as part of the enhancement intake processes, production issue resolution, and end-user engagement strategies.
- Communicate technology strategy, progress, and outcomes to senior leadership and key stakeholders through reports, presentations, and executive briefings.
- As the Technology leader for the Annual HEDIS regulatory audit, partner with the business to ensure process and submission approval and project milestones are met. Utilize a certified Cotiviti HEDIS engine to produce the annual HEDIS output and generate submission files for CMS.
- Produce bi-weekly Stars Prospective data runs utilizing Cotiviti to support Stars quality and clinical initiatives.
- Own the SDLC and ETL process by managing all source data for HEDIS and staging result for user consumption.
- Provides oversight to ensure accurate and complete quantitative analysis of clinical data and presentation of data analysis results.
- Oversees quality improvement activities for the largest, most complex health plan partners' programs.
- Document creation/population to Pathfinder for HEDIS projects.
- Hold the team accountable by monitoring Service Level Agreement (SLA) measures with the various technology support teams.
- Responsible for balancing workloads to optimize the effectiveness of the department.
- Responsibilities include, but are not limited to, effectively interviewing, hiring, terminating, and training employees; planning, assigning, and directing work; appraising performance; rewarding and counseling employees; addressing complaints and resolving problems; and supporting and encouraging the engagement process.
- Organize and maintain routine team communication venues.
- Implement individual staff development plans and periodically reassess progress.
- Seek process improvement opportunities.
- Resolve conflicts and grievances from customers and employees when necessary.
- As needed, represent Medicare Technology for HEDIS matters to various enterprise, shared service, and Government segment working committees.
- Understand and work effectively within the Company's investment decision-making processes (portfolio).
- Represent CRQC during weekly and Monthly HEDIS workgroup sessions.
- Attend cross-portfolio sessions to look for HEDIS impact - coordinate any estimation required.
- Author and communicate the HEDIS Technology Release roadmap.
- Foster a culture of innovation and continuous improvement within the technology function and across the organization.
- Using quick decision-making skills while constantly considering the overarching goals of the business & needs of various stakeholders.
- Bachelor's degree or related work experience is sufficient.
- Minimum 6+ years of relevant HEDIS/STARS experience.
- Experience using or partnering with Inovalon, Cotiviti, or similar platforms is preferred.
- Experience with HEDIS metrics and understanding changes in the metrics.
- Experience with ETL processes to build SSIS package(s) and automate processes.
- Proven track history of overseeing the execution of the HEDIS medical record retrieval process to ensure high outcomes
- Experience managing the IT function in an organization, aligning IT investments with business strategies, and determining IT investment priorities.
- Strong business understanding and the ability to translate business needs into technology strategies and solutions.
- Excellent analytical and problem-solving skills, with the ability to assess complex technology landscapes and provide strategic recommendations.
- Strong leadership skills with the ability to influence and collaborate effectively with cross-functional teams and senior leadership.
- Experience in driving digital transformation initiatives and implementing technology solutions at scale.
- Familiarity with project management methodologies and tools to oversee the execution of technology projects.
- Excellent communication and presentation skills, with the ability to convey complex technology concepts to non-technical stakeholders.
- Proficiency in data analysis tools and software (e.g., Excel, PowerPoint) to analyze technology data, create reports, and deliver presentations
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Senior Application Development Manager - Nashville, United States - Cigna
Description
Strategy SummaryOur team is an MA-focused group that provides direct and matrixed technology support for Cigna's Medicare Advantage and CareAllies business units. Our goal is to simplify how business gets technology delivered. We act as the accountable point of contact with the other shared service organizations across Cigna's technology landscape.
As a Senior Application Development Manager, you will serve as a dynamic technology leader responsible for ensuring customer needs are met with high-impact technology solutions. This will accelerate innovation and drive medical affordability and quality care for our members.
The Opportunity
You will join a highly visible team passionate about aligning local strategic objectives with tactical demands. We are seeking an experienced HEDIS leader who thrives on supporting sophisticated business challenges through technology, collaboration, analysis, and creativity. This role requires a blend of strategic thinking, technical expertise, and strong leadership skills to drive technological advancements and maximize the value of investments, all while navigating the complex healthcare landscape.
The role provides a unique opportunity to offer counsel and advice to top management on significant technical and strategic matters, often requiring coordination between organizations. The candidate must possess the technical skills to study and analyze systems needs and provide HEDISthought leadership and technical expertise across multiple disciplines, supporting our technology landscape.
The position reports directly to the Senior Director of Clinical, Risk Adjustment, Quality and CareAllies.
Responsibilities:
30% - Collaborate with senior leadership.
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: for support. Do not email 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.
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