The Cigna Group is seeking a Senior Director of Coverage Review Client Operations to provide strategic leadership in managing client-facing operations across Evernorth Health Services. The ideal candidate will possess extensive experience in healthcare operations, particularly in Medicare coverage review, and will be responsible for ensuring regulatory compliance and operational excellence
Job Summary
This enterprise leadership role is accountable for setting the strategic direction and operational standards for Coverage Review client-facing operations across Evernorth / Cigna Healthcare.
The position requires deep expertise in Medicare coverage review, including appeals, reconsiderations, and Independent Review Entity support, ensuring strict adherence to federal and state regulations.
Candidates must demonstrate a proven ability to partner with Account Management and lead client-facing operational models within highly regulated environments while driving operational excellence.
Matching Summary
Match Score: 85
The Cigna Group is seeking a Senior Director of Coverage Review Client Operations to provide strategic leadership in managing client-facing operations across Evernorth Health Services. The ideal candidate will possess extensive experience in healthcare operations, particularly in Medicare coverage review, and will be responsible for ensuring regulatory compliance and operational excellence.
Skills & Requirements
Must-have
12+ years healthcare operations experience
Deep expertise in Medicare coverage review
Strong knowledge of CMS regulatory requirements
Experience with Independent Review Entity support
Proven success leading enterprise implementations
Nice-to-have
Advanced degree MBA MHA MPH or PharmD
Executive presence and communication skills
Experience supporting PBM operations
Ability to influence decision-making across matrixed enterprise
Strong analytical judgment in high-risk environments