Clinical Program Development Lead Analyst, Lab Management Program- EviCore - Work at Home
Objectives: Our team brings coverage policies to life. We specialize in all aspects of laboratory medicine, from precision oncology and cutting-edge genomic testing to common screening and diagnostic lab tests. Medical necessity, billing requirements, and regulations come in many forms. Our job is to stay on top of that policy and enforce it in the most effective and efficient way possible, using a variety of automation tools and human resources. We are looking for someone with an analytical nature and clinical curiosity to support our lab solutions.
Minimum Qualifications: Master's Degree in genetic counseling, human genetics, or a related field. Board-certified by ABMG or ABGC. A minimum of 5 years clinical experience in genetic counseling. Utilization management/health plan, claims processing, and CPT coding experience highly desired
Must be able to:
Effectively and flexibly work with team members to achieve team goals.
Use strong analytical skills to break down complex processes into manageable pieces.
Employ good data organization and management practices with mastery of Excel. Access and/or SQL experience preferred.
Demonstrate excellent written and verbal communication skills.
Develop new and improved processes.
Initiate, lead and complete work without supervision.
Responsibilities (include but are not limited to):
Collaborate with clinical policy, review teams, and operations to identify opportunities for process improvements and efficiencies, particularly around post-service and claim appeal reviews.
Analyze claims and UM data to identify management needs, strategy, and effectiveness.
Provide oversight of clinical and coding aspects of a genomic test database.
Support implementation and maintenance of our correct coding product.
Develop new Lab Program products and capabilities as needed.
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.
For this position, we anticipate offering an annual salary of 75,500 - 125,800 USD / yearly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group.
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: [email protected] for support. Do not email [email protected] 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.
Apply Now
Minimum Qualifications: Master's Degree in genetic counseling, human genetics, or a related field. Board-certified by ABMG or ABGC. A minimum of 5 years clinical experience in genetic counseling. Utilization management/health plan, claims processing, and CPT coding experience highly desired
Must be able to:
Effectively and flexibly work with team members to achieve team goals.
Use strong analytical skills to break down complex processes into manageable pieces.
Employ good data organization and management practices with mastery of Excel. Access and/or SQL experience preferred.
Demonstrate excellent written and verbal communication skills.
Develop new and improved processes.
Initiate, lead and complete work without supervision.
Responsibilities (include but are not limited to):
Collaborate with clinical policy, review teams, and operations to identify opportunities for process improvements and efficiencies, particularly around post-service and claim appeal reviews.
Analyze claims and UM data to identify management needs, strategy, and effectiveness.
Provide oversight of clinical and coding aspects of a genomic test database.
Support implementation and maintenance of our correct coding product.
Develop new Lab Program products and capabilities as needed.
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.
For this position, we anticipate offering an annual salary of 75,500 - 125,800 USD / yearly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group.
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: [email protected] for support. Do not email [email protected] 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.
Apply Now