Responsibilities Drive Product and Business Outcomes
- Lead and develop a team of Advisors and Senior Advisors responsible for Medicaid Encounter capabilities and operational excellence.
- Establish strategic direction that supports compliance, client expectations, operational performance, and long-term business goals.
- Translate complex regulatory requirements into clear priorities, business requirements, and actionable solutions.
Influence Strategy and Execution
- Partner with business, technical, legal, compliance, and operational teams to deliver large-scale cross-functional initiatives.
- Guide product roadmaps and priorities using agile practices and a deep understanding of client and business needs.
- Analyze trends, risks, and opportunities to recommend improvements that strengthen performance and enhance client outcomes.
- Communicate recommendations and progress to leaders, stakeholders, clients, and account teams.
Serve as a Trusted Subject Matter Expert
- Act as a recognized expert in Medicaid Encounter programs and regulated market capabilities.
- Interpret regulatory guidance and help ensure compliant implementation across teams and processes.
- Represent the organization in client meetings, industry forums, audits, and cross-functional discussions.
- Develop and deliver training that builds capability and supports organizational growth.
Strengthen Operational Excellence
- Ensure policies, procedures, controls, and monitoring activities are well documented and consistently followed.
- Oversee project plans, deliverables, timelines, and communications to drive successful outcomes.
- Support issue resolution through data analysis, system expertise, and cross-functional collaboration.
- Foster a culture of continuous improvement, learning, accountability, and teamwork.
Qualifications Required Qualifications
- 5+ years of experience in pharmacy benefit management (PBM), regulated markets, healthcare operations, product management, or a related field.
- Experience leading people, teams, projects, or large-scale business initiatives.
- Knowledge of pharmacy adjudication processes and PBM operations.
- Strong strategic thinking, analytical, problem-solving, and project management skills.
- Ability to interpret complex regulations and translate them into business actions and operational requirements.
- Excellent verbal, written, and presentation skills, including the ability to communicate complex information to diverse audiences.
- Demonstrated ability to influence stakeholders across multiple functions and levels of the organization.
- Proven ability to adapt, learn quickly, and drive results in a changing environment.
Preferred Qualifications
- Bachelor's degree in Business, Healthcare Administration, Information Systems, or a related field.
- Experience managing Medicaid, Medicare, or other regulated market capabilities.
- Experience leading large-scale healthcare regulatory or compliance-related initiatives.
- Familiarity with industry standards organizations and regulatory environments.
- Advanced skills in Microsoft Excel, Microsoft Access, SQL, or related data analysis tools.
- Experience working within agile product development environments.
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 131,400 - 219,000 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.
At The Cigna Group, 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), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence. For more details on our employee benefits programs, click here.
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.