Job Description:  Director for Regulated Markets – CDAG/ODAG

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Role Summary: 

The Director of Regulated Markets is responsible for Coverage Review and Determinations for Medicare Part B and Part D, Medicaid, Marketplace or Healthcare Reform (HCR) and Commercial. This position will have business and product ownership, including strategic direction, project support of technical requirements to ensure ongoing compliance, Center for Medicare and Medicaid (CMS) Audit support and end-to-end ownership of Coverage Review letters, including Commercial.

The role will be responsible for ensuring CDAG/ODAG requirements meet legal and compliance requirements as well as the needs of clients and business partners.  This position will be responsible for a team of individuals that lead multiple projects and initiatives that reach across the organization as well as ongoing day-to-day product management.  This role will require strategic planning, managing stakeholder priorities, overseeing delivery, execution and oversight of daily operations.  This individual will work with cross-functional partners and leaders to build trusted relationships that enable business objectives to be met.  The ideal candidate will have a broad based knowledge of Regulated Markets, a strategic mindset, the ability to influence and drive change and the capability to create and drive new processes.  The successful leader will exemplify Cigna’s high-performance culture and have the ability to operate in a sometimes ambiguous and high-paced environment.  A successful candidate must be comfortable in an environment of dynamic change and evolution.

In its current capacity, the Director will be expected to manage a team of 8 individuals (3 direct reports; 5 indirect).

Essential Functions:

Analyze existing processes/systems to ensure legal/compliance requirements are met as well as business and client needsResponsible for area performance, inclusive of key KPIs, minimizing and mitigating business risksCoordinate with cross-functional partners to understand, analyze and ultimately implement improvements, increase operational efficiency and/or address gaps in CDAG/ODAGProvide influence, subject matter expertise and strategic support on new product launches within the organization that affects CDAG/ODAGBuilds constructive and effective relationships across the companyImplement applicable regulations with vague/ambiguous requirements in a dynamic regulatory environmentOptimize core business processes, introduce innovative ideas, and foster operational excellence across the organizationEffectively communicate strategies and deliverables with clients, account teams and leadershipUnderstands business impacts to the PBM as well as clients and member experience when making recommendations for viable solutionsAnticipate, mitigate, and manage risk within team scopeBe the senior point for issue escalation and resolution for issues involving CDAG/ODAGMaintain relevant tools, reporting, documentation, processes, guides, and training so that they are available and implemented across the enterprise.Effectively participates in, and contributes to, staff meetings, committees and departmental work groups to share best practices, improve processes, and/or other items relating to provider engagementAbility to see things differently, and act in a nimble manner to address requirementsLead, coach, and develop individuals to maintain a high performing team

Qualifications:

Bachelor’s degree required; MBA or PharmD preferred10+ years relevant experienceA result-focused executor, who brings discipline, drive, and accountability to ensure delivery of key initiativesDetailed knowledge and expertise of the regulated markets and the PBM industryAdept at working with senior leaders and developing key relationshipsAbility to work cross functionally with multiple departments to gain consensus and move projects and initiatives forwardExperience in attracting top talent, building and developing effective teamsAble to synthesize regulations and present them to clients and account teams in an effective mannerDemonstrated ability to set priorities including, but not limited to time management and organizational skillsProven track record of delivering high quality resultsSuccessful results leveraging data and analytics to gain actionable insights that enable product/solution development and business growthExperience in managing and implementing large scale initiatives preferredStrong strategic, analytical, problem solving, and project management skills requiredAble to create a sense of purpose and meaning for the team that generates followership beyond their own personality and engages others to advance the company’s greater purposeAble to overcome resistance to ensure the appropriate outcomeNaturally connects and builds strong relationships with others, demonstrating strong emotional intelligence and an ability to communicate clearly and persuasively

Required Competencies/Behaviors:

Strong in strategy development, communication and executionClient centric / customer focusedAbility to build strong relationshipsAbility to build and manage strong internal teamsDemonstrate the ability to negotiate cross functionally to drive client issues to resolutionAbility to manage work strategically, effectively anticipating/planning for client impact of internal and external influencers

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 Evernorth Health Services

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. 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.