(RN) Clinical Program Senior Advisor, Cigna Coverage Policy Unit - ENCORE

Description

This position includes responsibility for conducting research and analysis of published medical literature in order to respond to internal and external inquiries and the development of Cigna Medical Coverage Policies. This includes identification of opportunities for CP development and core clinical evidence review through the Medical Technology Assessment process. The role supports all product lines of business-Employer Group, Individual, Medicare, Disability, Cigna Global., SAR, Payer Solutions, and QualCare. This position has significant interdisciplinary policy connections; the individual in this role must be comfortable, experienced and successful working in a team culture.

Responsibilities

• Develops evidence-based medical coverage policies (CPs) through analytic evaluation of published medical literature.
• Understands levels of evidence and is able to discuss the quality of a study to ensure coverage policies and medical inquiry responses transparently convey the strengths, weaknesses, and implications of published evidence.
• Analyzes data to identify utilization trends, ensure maximum policy implementation, and to identify potential total medical cost (TMC) opportunities
• Presents proposals to the TMC committee for consideration; once a project is recommended to move forward, acts as a critical member of the project team to bring the initiative through the governance process and implementation
• Engages with the Precertification Committee to evaluate adding / removing codes from precert based on assessment of utilization trends and ROI
• Provides clinical expertise as a voting member in the NAU second level appeals calls
• Participates in National Clinical Updates and Pearls (CUPS) Calls, with UM RNs and Medical Directors, responding to questions and providing clarification on new and revised Coverage Policies.
• Effectively partners with Coverage Policy Unit (CPU) medical policy team, manager, CPU Medical Director, clinical subject matter experts, and external vendors to meet business needs and strategic goals
• Presents new and revised coverage policies in monthly Medical Technology Assessment Committee meetings in a concise, articulate manner, demonstrating a thorough understanding of the topic and key issues.
• Works with other team members to ensure that coverage policies are implemented, deployed to internet sites, and changes communicated within and outside the organization.
• Participates in projects within the Coverage Policy Unit as needed

Qualifications