RN Clinical Quality Sustainment Coach - Evernorth Health Services - Remote

Cigna Healthcare

6d • Remote

About The Position

Reporting to the Clinical Quality Supervisor, the Clinical Quality Sustainment Coach (QSC) is responsible for performing quality reviews of clinical cases and call recordings within Cigna operational systems. This role delivers direct feedback and coaching to operational front-line staff based on review outcomes to drive quality improvement, consistency, and improved member outcomes. The QSC supports quality analysis and contributes to quality improvement initiatives across Care Solutions, with oversight from leadership.

Requirements

• Active, unrestricted Registered Nurse (RN) license in state of residency
• Minimum of three (3) years of nursing experience.
• Clinical experience in Case Management
• Strong clinical expertise with an understanding of operational workflows, SOPs, policies, and procedures relevant to the assigned area.
• Proficiency with Microsoft Word, Excel, SharePoint, WebEx, and Outlook.
• Excellent verbal and written communication skills.
• Demonstrated coaching skills with the ability to provide positive, constructive feedback.
• Ability to recognize and acknowledge individual and team successes.
• High emotional intelligence with the ability to quickly build professional, trusting relationships.
• Strong analytical skills with the ability to identify trends, action steps, and improvement opportunities.
• Ability to assess quality both quantitatively and qualitatively.
• Detail-oriented with strong time management, organization, and multitasking skills.
• Comfortable raising questions, ideas, and recommendations across all levels of the organization.
• Ability to work independently and collaboratively as part of a team.
• Acts as a positive role model aligned with Cigna values.

Nice To Haves

• Experience with clinical and operational systems such as Knowledge Exchange, CCV, OneView, ICMS, TruCare, Verint, or similar platforms.
• Client audit experience.
• Prior experience as a team lead, subject matter expert, or preceptor.
• 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

• Champion Cigna’s Consumer Health Engagement Cultural Beliefs: Customer Strong, Me to We, Own It!, Be Bold, Listen to Advocate, Think It Through.
• Serve as a subject matter expert (SME) for assigned clinical and operational areas.
• Conduct quality reviews to ensure documentation accuracy and adherence to established quality standards.
• Deliver timely, constructive coaching to front-line staff, highlighting successes and opportunities for improvement.
• Ensure quality reviews are accurately tracked and documented within designated quality review tools.
• Explain and reinforce foundational quality principles and expectations.
• Review quality performance data with front-line staff and operational leadership on a monthly basis.
• Identify, interpret, and explain department quality metrics.
• Exchange quality practices and procedural guidance with matrix partners.
• Develop, analyze, and distribute case and call quality review reports.
• Collaborate with Readiness & Support (R&S) team members to address trends and improvement opportunities.
• Partner with Readiness Team Learning Facilitators to support new hire development and close identified knowledge gaps.
• Identify adherence gaps, discrepancies, and error trends; escalate findings and recommendations to operational leadership.
• Participate in departmental projects, initiatives, and stretch assignments as assigned.

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
• Education Level: No Education Listed