Special Needs Plan Administrator of Operations - Work At Home

Cigna - Nashville, TN3.7

Full-time
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Special Needs Plan Administrator of Operations, C-HS

The Special Needs Plan (SNP) Administrator drives accountability across the segment to ensure performance indicators are achieved, care management is provided, and policy and procedures are consistently administered to all customers while meeting our compliance/regulatory obligations

Role Summary

The Administrator will be responsible for leading the end to end process for the Senior Segment SNP Model of Care (MOC) including SNP Oversight, the Customer Contact Center for Health Risk Assessment (HRA), Clinical Resource Unit (CRU), Health Risk Assessment (HRA) process for the Medicare Advantage non-SNP customers, the Field Markets and Behavioral Health (BH), and vendors – HGS, Axis, and RRD. In this role, the Administrator will partner with Compliance, Health Services Leads, STARS, IT, HEDIS, Sales, Pharmacy, and Shared Services to develop and execute the plans and initiatives to drive regulatory compliance, case management, customer experience, operational efficiencies, and business results. The candidate will partner with Business Development to establish the capability requirements for membership growth and expansions. This role will drive accountability and performance metrics for a high volume health engagement customer contact center, and monitor service and value delivery to CMS and customers. Additionally, the role will be responsible for managing consistency of process across all operational and functional areas, establishing policy and procedures, training/knowledge management and development.

Role Components
  • SNP Leadership: Serve as the single voice on all aspects of the SNP MOC business (people and process) to ensure collaborative communication (two way information flow) & timely decision making focused on the goal of driving collective success across the Senior Segment. Build collaborative relationships with matrix partners to achieve the very best case management and customer experience.
  • Ensure end to end consistency/ execution across all Markets, Functional Areas, (High/Moderate/Low, Behavioral, HRA) and Oversight. Help to remove barriers and roadblocks
  • SNP Strategy & Planning: Oversee the strategy development/execution and articulate the vision for SNP to achieve performance results and revenue/growth goals. Ensure that funding and resources are prioritized and committed to complete actions, and resolve resource gaps. Monitor whether actions achieved compliance/regulatory obligations, financial goals and revise future strategy and plans. Support the Business Development Leads in their efforts to build membership in the market expansion efforts.
  • Talent Development: Accountable for optimizing SNP-aligned talent, in partnership with the Health Services Lead team, across the Segment. Identify actions necessary to upgrade talent, and oversee creation and implementation of training and development actions across the Segment. Ensure an active talent pipeline for the SNP Functional and Operational areas.
  • Shared Service Interface: Drive matrix management of key internal partners to include, but not limited to, Compliance, IT, STARS, HEDIS, and CCSE.
  • Project Leadership: Serve as clearinghouse for incoming projects specific to SNP MOC or those that will impact SNP resources; work with Health Services Leadership to determine net business impact of project deliverables and identify/deploy appropriate subject matter expertise.
  • Management Process and Reporting: Leverage data and information to drive business results - Customer level tracking/Transition of Care (ICT, ICP, HRA); Market/executive dashboards (usable/easy to understand); Management structure and clarity of roles & responsibilities; and Best Practices and workflow efficiencies across markets/functional areas
  • Continuous Quality Improvement: Training material and standard operating procedures - easy to follow and understand; Quality audits formal feedback loop – (coaching, trends, learning sessions); and All EE SNP MOC Learning sessions
Role Scope
  • Direct and dotted line reporting structure will include:
o Band 4 HRA/CRU Operations Manager – Direct Report
o Band 4 SNP Operations/Quality Oversight – Direct Report
o Band 4 MOC Management & Consistency of Process – Direct Report
o Band 5 Field Market Health Services Leads (5) – Dotted Line Reports
o National Vendors (3)
  • 85k SNP Customers
  • 350k MA – Non SNP Customers (Health Risk Assessment Process)
Minimum Qualifications
  • A seasoned, respected leader with a minimum of 10 years of experience in the healthcare industry, with specific experience in managing clinical and business operations.
  • Working knowledge and understanding of Special Needs Plans and Case Management
  • Bachelor’s degree required; advanced degree desirable.
  • Ability to travel 25%
Competencies Required
  • Leadership and Organization - Exceptional capacity for managing and leading people and cross-functional teams; a team builder who has experience in scaling up organizations; ability to connect with staff both on an individual level and in large groups; capacity to enforce accountability, develop and empower the team and top-notch leaders; empower and engage others; learn the strengths and weaknesses of the team so as to put people in a position to succeed. Proven ability to inspire change
  • Results Orientation - Proven track record of exceeding goals and a bottom-line orientation; evidence of the ability to consistently make good decisions through a combination of analysis, wisdom, experience, and judgment; high level of business acumen, including the ability to balance the delivery of programs against the realities of a budget; problem solving, project management, and creative resourcefulness.
  • Strategic Vision and Agility - Ability to think strategically, anticipate future consequences and trends, and incorporate them into the organizational plan
  • Technical/Business Knowledge - Experience and depth of understanding in case management, care management, consistency of process, policy and procedures, quality and coaching, SNP MOC
  • Customer Focus –Is dedicated to meeting the expectations and requirements of CMS; gets first-hand customer information and uses it for improvements in experiences and services; acts with customer health and well-being in mind.
  • Matrix Management/Relationship Building – Enterprise thinker with proven ability to influence across a matrix environment. Ability to develop strong relationships across all levels of the organization, and with external partners. Must build credibility with internal matrix leadership across the segment.
  • Communication - Strong persuasion skills and effective communicator; ability to create and communicate a compelling vision
  • Action Oriented - Enjoys working hard and looks for challenges; able to act and react as necessary, even if limited information is available; not afraid to take charge of a situation; can overcome resistance to leadership and take unpopular stands when necessary.
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Qualified applicants will be considered for employment without regard to age, race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status.
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If you require an accommodation based on your physical or mental disability please email: SeeYourself@cigna.com. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.