Senior Director, Coverage Review Client Operations - Evernorth Health Services (hybrid)

Express Scripts

**
12+ years healthcare operations experience
Deep expertise in medicare coverage review
Strong knowledge of cms regulatory requirements
** The Senior Director of Coverage Review Client Operations at Evernorth Health Services, a part of Express Scripts, is a leadership role responsible for overseeing complex, regulated operations related to coverage reviews, particularly in Medicare programs. The position requires extensive experience in healthcare operations and strong collaboration with various stakeholders to ensure compliance, operational excellence, and a superior client experience. **

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-related operational support, including appeals, reconsiderations, and Independent Review Entity (IRE) support, ensuring strict regulatory compliance.
  • The Senior Director will lead a multi-layer leadership team to drive operational excellence, balance compliance with cost efficiency, and ensure audit readiness across multiple lines of business.

Matching Summary

Match Score: 75

** The Senior Director of Coverage Review Client Operations at Evernorth Health Services, a part of Express Scripts, is a leadership role responsible for overseeing complex, regulated operations related to coverage reviews, particularly in Medicare programs. The position requires extensive experience in healthcare operations and strong collaboration with various stakeholders to ensure compliance, operational excellence, and a superior client experience. **

Skills & Requirements

Must-have

  • 12+ years healthcare operations experience
  • Deep expertise in Medicare coverage review
  • Strong knowledge of CMS regulatory requirements
  • Experience leading enterprise implementations
  • Proven ability to partner with Account Management

Nice-to-have

  • Advanced degree (MBA, MHA, MPH, PharmD)
  • Executive presence and communication skills
  • Experience supporting PBM or utilization management
  • Strategic partnership with Product and Technology teams

Key Requirements

  • Bachelor's degree required; advanced degree preferred
  • 12+ years progressive experience in healthcare operations
  • Leadership roles within large, complex, highly regulated organizations

Work Rights

Not specified

Tailored Resume

Cover Letter