Senior Manager of Quality, Coaching, and Audit Programs - Evernorth Behavioral Health - Hybrid

$123,000 - $205,000/Yr

Cigna - Bloomington, MN

Full-time - Senior

Hybrid - Bloomington, MN

Insurance Carriers and Related Activities

About the position

The Senior Manager of Quality, Coaching, and Audit Programs will develop and execute a comprehensive operational quality and coaching program for non-clinical and clinical behavioral health staff. This program is crucial for maintaining and enhancing service quality and ensuring compliance with industry regulations. This role will oversee onshore clinical and non-clinical quality teams as well as develop, execute and maintain an offshore quality support structure in collaboration with offshore resource teams. In addition to operational quality, this role is responsible for oversight of the Behavioral external audit team, collaborating with Medical External Audit team and external consultants to support our Cigna/Evernorth External Audit process.

Responsibilities

• Evaluate current state Operational Quality & Coaching Program; develop/enhance and execute a comprehensive operational quality and coaching program for non-clinical and clinical behavioral health staff.
• Develop, execute and maintain an offshore quality strategy to supplement onshore activities that allows our organization to utilize resources in the most effective and efficient manner in support of the overall Quality & Coaching Program.
• Ensure all quality processes/procedures support and are aligned to business expectations, process, policy/procedure and accreditation standards. Maintain regular connection and collaboration with business leaders and key stakeholders to ensure clarity and alignment on quality standards.
• Maintain consistency across both onshore and offshore teams ensuring that their work aligns with program goals and objectives. This will involve regular training and feedback sessions (IRR) to uphold consistency, high performance and adherence to best practices.
• Lead Supervisors and/or managers of clinical quality, non-clinical quality and Behavioral External Audit teams. Provide direct reports with clear expectations to drive positive team culture and results for the organization.
• Ensure a quality reporting structure is in place with regular program performance metrics outlined at the individual, team, and organizational level for aligned business areas and key stakeholders.
• Regularly analyze program performance metrics and data to identify opportunities for enhancement and optimization. Report findings and recommendations to senior management to drive continuous quality improvement.

Requirements

• Bachelor's degree in a related field; Master's degree preferred, ideally in business or healthcare related field of study.
• 8+ years of progressive experience in quality management, audit, or coaching, focusing on behavioral health or healthcare/managed care environments.
• Proven experience managing and leading teams, including remote or/or offshore team members.
• Knowledge of industry regulations, accreditation standards (ex. NCQA, URAC) and quality improvement methodologies.
• American Society of Quality (ASQ) Quality Manager Certification and/or Certified Professional in Healthcare Quality (CPHQ) required or ability to obtain within a year of hire.
• Strong understanding of non-clinical and clinical staff roles and responsibilities within the behavioral health industry.
• Excellent communication, interpersonal, and problem-solving skills.
• Highly Skilled in Matrix Partner Collaboration.
• Proven ability to learn new systems, technologies and processes quickly and efficiently.

Benefits

• Comprehensive health-related benefits including medical, vision, dental, and well-being and behavioral health programs starting on day one of employment.
• 401(k) with company match.
• Company paid life insurance.
• Tuition reimbursement.
• A minimum of 18 days of paid time off per year and paid holidays.