Job Summary:

Cigna is seeking an experienced Clinical Policy Lead Analyst to join our team in a remote capacity. The ideal candidate will be responsible for developing, analyzing, and overseeing clinical policies that support healthcare quality, regulatory compliance, and cost-effective treatment options. This position is crucial in ensuring that Cignas clinical policies align with the latest medical guidelines and industry best practices while facilitating superior member outcomes.

Key Responsibilities:

• Lead the development and implementation of clinical policies to support medical management programs.
• Conduct thorough research and analysis of clinical data, guidelines, and emerging trends to inform policy development.
• Collaborate with cross-functional teams, including medical directors, claims analysts, and legal departments, to ensure policy alignment and compliance with regulatory standards.
• Provide expert guidance and recommendations for policy changes or new policy development based on clinical evidence, stakeholder feedback, and healthcare trends.
• Review clinical policy changes with senior leadership, providing strategic insights into potential impacts on cost and quality.
• Serve as a subject matter expert in clinical policy matters, responding to inquiries and providing clarification on policy details.
• Monitor policy effectiveness and propose improvements to enhance operational efficiency and healthcare outcomes.
• Ensure timely completion of all assigned projects while adhering to deadlines and quality standards.

Required Skills and Qualifications:

• Bachelors degree in Nursing, Healthcare Administration, Public Health, or a related field. Advanced degrees (e.g., Masters) preferred.
• Active clinical license (RN, MD, or equivalent) is preferred.
• Strong knowledge of clinical guidelines, medical coding, and healthcare regulations.
• Proficiency in medical policy development, utilization management, and evidence-based medicine.
• Excellent communication and interpersonal skills to interact effectively with internal teams, clients, and stakeholders.
• Advanced problem-solving abilities, with a keen attention to detail.
• Ability to work independently and prioritize tasks in a fast-paced, remote environment.

Experience:

• Minimum of 5 years of clinical experience in healthcare settings such as hospitals, insurance, or managed care.
• At least 3 years of experience in clinical policy development, analysis, or a related field.
• Experience working with healthcare data, clinical guidelines, and regulatory requirements is essential.
• Prior experience with remote work is an advantage.

Working Hours:

• Full-time position with flexible working hours, in alignment with team needs and project deadlines.
• This role is fully remote, offering a flexible work schedule with occasional team meetings.

Knowledge, Skills, and Abilities:

• In-depth understanding of clinical policy frameworks, medical necessity criteria, and healthcare quality standards.
• Ability to analyze complex clinical data and translate it into actionable policy recommendations.
• Strong understanding of HIPAA regulations, compliance issues, and industry best practices.
• Proficiency in MS Office Suite and familiarity with healthcare data management systems and software.
• Ability to thrive in a remote work environment and effectively manage multiple priorities.

Benefits:

• Competitive salary and performance-based incentives.
• Comprehensive health benefits including medical, dental, and vision coverage.
• Generous paid time off (PTO) and paid holidays.
• Retirement savings plan with employer match.
• Access to professional development resources and training programs.
• Employee wellness programs and mental health support services.
• Flexible work hours and remote work options.
• Paid parental leave and other family support programs.

Why Join Cigna?

At Cigna, we are dedicated to improving the health, well-being, and peace of mind of those we serve. By joining our team, you will have the opportunity to be part of a global health service company that values diversity, innovation, and collaboration. We offer a supportive work culture where you can grow professionally and contribute to transforming healthcare for the better.

How to Apply:

To apply for the Clinical Policy Lead Analyst position, please submit your updated resume and a cover letter outlining your relevant experience and qualifications. Applications can be submitted through our careers portal on the Cigna website.