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POSITION SUMMARY
The Director of Regulated Markets Centene Operations Management will direct and assess the account management services provided to Centene specific to Regulated Markets processes for communications, audits, issue management, and adjustment processing. The director will manage ongoing internal relationships in support of Centene to ensure the quality, consistency and satisfaction of services delivered. The role will also facilitate interdepartmental communication and manage the team toward the primary objectives of meeting member/client satisfaction, aligning with client contractual support and client retention.
In its current capacity, the Director will be expected to manage a team of over 9 individuals (2 direct s; 7 indirect).
Essential Functions:
- Build trusted relationships within Regulated Markets, PBM Operations and Centene Account Management to ensure that teams remain aligned with delivering items to meet client commitments
- Optimize core business processes, introduce innovative ideas, and foster operational excellence across the organization
- Ensure teams manage document creation and annual updates to member communications. Collaborate internally to ensure updates are completed in a timely manner
- Ensure PBM delegated communications to meet clientsxe2x80x99 contractual mandates & PGs – Anticipate, mitigate, and manage risk within team scope
- Lead, coach, and develop individuals to maintain a high performing team
- Work with RM Audit Readiness team, Government audit, Centene account team on all audits inclusive of initiation communication, prep for audit and coordination of audit deliverables
- Lead team ensuring that processes and systems are aligned for adjustment client coordination and approvals
- Develop and help manage process to enable PDE and encounter error resolution and client engagement
- Partner across the organization on client issues ensuring that all issues meet client notification and resolution requirements.
Qualifications:
- Bachelorxe2x80x99s degree required; MBA or other Masters level degree preferred
- 10-14 years relevant PBM space
- A result-focused executor, who brings discipline, drive, and accountability to ensure delivery key regulated markets operational deliverables
- Detailed knowledge and expertise of the regulated markets and the PBM industry
- Adept at working with senior leaders and developing key relationships
- Ability to work cross functionally with multiple departments to gain consensus and move projects and initiatives forward
- Experience in attracting top talent, building and developing effective teams.
- Demonstrated ability to set priorities including, but not limited to time management and organizational skills.
- Proven track record of delivering results of high quality work
- Strong strategic, analytical, problem solving, and project management skills required
- Able to create a sense of purpose and meaning for the team that generates followership beyond their own personality and engages others to advance the companyxe2x80x99s greater purpose.
- Able to overcome resistance to ensure the appropriate outcome
- Naturally connects and builds strong relationships with others, demonstrating strong emotional intelligence and an ability to communicate clearly and persuasively
Required Competencies/Behaviors:
- Client centric / customer focused
- Ability to build strong relationships
- Ability to build and manage internal teams
- Demonstrate the ability to negotiate cross functionally to drive client issues to resolution
- Ability to manage work strategically, effectively anticipating/planning for client impact of internal and external influencers
This is a hybrid role and will require the ability to work in-person.
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.
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.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: [email protected] for support. Do not email [email protected] for an update on your application or to provide your resume as you will not receive a response.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
