Program Management Advisor, Medical Utilization Management - Cigna Healthcare - Remote

The Cigna Group

1d • Remote

About The Position

The Medical Management Program Advisor is a key leadership role within Cigna Healthcare, responsible for driving oversight, governance, and performance excellence across medical management programs.
This position serves as a strategic connector between clinical operations, governance committees, and performance monitoring, ensuring initiatives that improve patient care quality, operational efficiency, and regulatory compliance.
The Advisor plays a pivotal role in aligning utilization management processes with organizational goals, facilitating governance structures, and supporting cross-functional teams to deliver best-in-class care. By managing delegated programs, overseeing appeals, and implementing performance metrics, this role ensures clinical strategies are executed effectively and stakeholders remain informed and engaged.
This position requires exceptional coordination, analytical, and leadership skills, with the ability to navigate complex healthcare environments. The Advisor is instrumental in shaping strategies that advance affordability, quality improvement, and risk mitigation—ultimately driving better health outcomes and sustainable business practices.

Requirements

• Education: Bachelor’s degree in healthcare administration, nursing, or related field (Master’s preferred).
• Experience: Minimum 5 years in medical management, utilization management, or clinical operations.
• Strong knowledge of utilization management, appeals processes, and delegated program oversight.
• Proven ability to lead cross-functional teams and manage complex projects.
• Excellent communication, facilitation, and stakeholder engagement skills.
• Experience with performance metrics, KPIs, and reporting tools.
• Familiarity with regulatory requirements and risk management in healthcare.
• Proficiency in data analysis and healthcare reporting systems.

Responsibilities

• Serve as the primary liaison for medical management leadership, triaging requests and providing timely updates.
• Partner in the design and refresh of the medical management oversight model for delegated programs.
• Facilitate governance structures for utilization management and clinical strategy committees.
• Develop, refine, and deliver reporting packages for utilization management performance and key metrics.
• Oversee delegated programs, including performance tracking, reviews, and accountability measures; lead remediation efforts as needed.
• Monitor appeals processes to ensure compliance with regulatory requirements and mitigate risk.
• Collaborate with cross-functional teams to align medical management strategies with organizational objectives.
• Prepare and present senior-level communications, including periodic status reports and monthly updates.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level