Clinical Program Officer, Diagnostic Solutions

Cigna Healthcare

About The Position

The Clinical Program Officer, Diagnostic Solutions has primary clinical oversight of EviCore by Evernorth’s radiology, cardiovascular, sleep, and gastroenterology management programs and services. Responsibilities include: Lead overall clinical program performance for all radiology, cardiovascular, sleep and gastroenterology and other assigned programs based on business need, including policy, clinical review decision, appeals, audits, and other clinical functions Supervise performance of clinical reviewers in radiology, cardiovascular, sleep, and gastroenterology programs Collaborate as program clinical contact for client medical leadership concerning clinical policy, quality, program development, clinical criteria, and provider issues for radiology, cardiovascular, sleep, and gastroenterology programs. Diagnostic Solutions clinical contact for client medical leadership concerning clinical policy, quality, program development, clinical criteria, and provider issues for radiology, cardiovascular, sleep, and gastroenterology programs Evaluate utilization trends, referral patterns, fraudulent medical practices, quality standards, regulatory changes, program performance, and client feedback for radiology, cardiovascular, sleep, and gastroenterology services, and recommend solutions for improvement where needed. Oversee clinical policy development for all radiology, cardiovascular, sleep, and gastroenterology programs, and facilitate collaboration with other clinical programs to ensure optimal process and content harmonization Collaborate with Talent Acquisition and Clinical Operations as subject matter expert (SME) for radiology, cardiovascular, sleep, and gastroenterology program clinical hires Participate as senior leadership in strategy, planning, and budgeting for radiology, cardiovascular, sleep, and gastroenterology programs as well as in execution of annual program goals, accountable to the General Manager of Diagnostic Solutions Collaborate with Talent Acquisition and Clinical Operations as subject matter expert (SME) for radiology, cardiovascular, sleep, and gastroenterology program clinical hires Attend key professional meetings and support marketing initiatives as a representative thought leader of EviCore for Diagnostic Solutions topics. Establish informal and formal mechanisms to promote and maintain credibility, competence, and positive corporate image by exhibiting effective communication to clients, providers, committees, and employees. Drive a culture of open communication and transparency across all stakeholders. Remain flexible in the face of ongoing change as the organization evolves. Ensure EviCore radiology, cardiovascular, sleep, and gastroenterology program compliance with all NCQA, URAC, and other regulatory requirements and oversee clinical program support to audit teams. Participate in all required educational and quality improvement activities and maintain passing scores in all assessments. Supports other duties based on business need and priority.

Requirements

M.D. or D.O. degree from an accredited institution.
Minimum of five (5) years of clinical practice experience after completion of all graduate medical education training, including residency and fellowship (when applicable)
Active board certification in medical or surgical specialty or subspecialty
Active unrestricted license to practice medicine in a state or territory of the United States as a Doctor of Medicine or Doctor of Osteopathic Medicine.
Knowledge of applicable state and federal laws, CMS, URAC and NCQA standards, and utilization management
Minimum experience required (number of years necessary to perform role): Three (3) or more years of managed care experience
Supervisory and/or management experience; 5+ years of people leadership preferred.
Familiarity with automated processes and computer applications/systems is required.
Collaborates & Communicates Effectively
Drives Engagement & Develops Talent
Builds Networks - Cultivates relationships across boundaries to enhance collaboration and resource sharing.
Drives Results - Inspires teams to achieve ambitious goals, even in challenging circumstances, by removing barriers and celebrating progress.
Ability to connect daily actions to long-term organizational objectives, ensuring that results contribute to the broader mission.
Strategic Mindset - Anticipates future trends and positions the organization for long-term success.
Ability to develop and communicate a compelling vision, translate strategy into actionable plans, and adjust direction as needed in response to changing conditions.
Manages Complexity - Navigates ambiguity and synthesizes complex information to make informed decisions.
Focuses on guiding teams through uncertainty, providing clarity and structure during transitions.
Models adaptability and a growth mindset, encouraging others to embrace change.
Ensures Accountability - Holds self and others responsible for achieving high standards and delivering on commitments, fostering a culture of ownership and trust.
Sets clear expectations and measures progress, ensuring that change initiatives are implemented with transparency and follow-through.
Aligns accountability structures with organizational strategy to drive sustainable results.
Instills Trust - Builds credibility through authentic communication, ethical behavior, and consistent follow-through.
Fosters psychological safety, enabling open dialogue and honest feedback amongst colleagues and teams.
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.

Responsibilities

Lead overall clinical program performance for all radiology, cardiovascular, sleep and gastroenterology and other assigned programs based on business need, including policy, clinical review decision, appeals, audits, and other clinical functions
Supervise performance of clinical reviewers in radiology, cardiovascular, sleep, and gastroenterology programs
Collaborate as program clinical contact for client medical leadership concerning clinical policy, quality, program development, clinical criteria, and provider issues for radiology, cardiovascular, sleep, and gastroenterology programs.
Diagnostic Solutions clinical contact for client medical leadership concerning clinical policy, quality, program development, clinical criteria, and provider issues for radiology, cardiovascular, sleep, and gastroenterology programs
Evaluate utilization trends, referral patterns, fraudulent medical practices, quality standards, regulatory changes, program performance, and client feedback for radiology, cardiovascular, sleep, and gastroenterology services, and recommend solutions for improvement where needed.
Oversee clinical policy development for all radiology, cardiovascular, sleep, and gastroenterology programs, and facilitate collaboration with other clinical programs to ensure optimal process and content harmonization
Collaborate with Talent Acquisition and Clinical Operations as subject matter expert (SME) for radiology, cardiovascular, sleep, and gastroenterology program clinical hires
Participate as senior leadership in strategy, planning, and budgeting for radiology, cardiovascular, sleep, and gastroenterology programs as well as in execution of annual program goals, accountable to the General Manager of Diagnostic Solutions
Collaborate with Talent Acquisition and Clinical Operations as subject matter expert (SME) for radiology, cardiovascular, sleep, and gastroenterology program clinical hires
Attend key professional meetings and support marketing initiatives as a representative thought leader of EviCore for Diagnostic Solutions topics.
Establish informal and formal mechanisms to promote and maintain credibility, competence, and positive corporate image by exhibiting effective communication to clients, providers, committees, and employees.
Drive a culture of open communication and transparency across all stakeholders.
Remain flexible in the face of ongoing change as the organization evolves.
Ensure EviCore radiology, cardiovascular, sleep, and gastroenterology program compliance with all NCQA, URAC, and other regulatory requirements and oversee clinical program support to audit teams.
Participate in all required educational and quality improvement activities and maintain passing scores in all assessments.
Supports other duties based on business need and priority.

Benefits

For this position, we anticipate offering an annual salary of 260,200 - 433,600 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 and long term incentive 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 and paid holidays.

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