Job Overview:
This role is responsible for driving the Clinical Quality data acquisition strategy and data product support within the Enterprise Quality & Accreditation organization. The data being acquired will be used to measure clinical quality results that ultimately allow Cigna to benchmark against competitors, and drive improvements in patient outcomes. This data will feed into HEDIS and NCQA accreditations. This position will be responsible for driving the multi-year roadmap of data work and will directly enable the transition towards digital quality measures (dQM) as mandated by regulatory needs. This position leads a team inclusive and not limited to a Clinical Data Governance Lead and a Clinical Data Steward. Responsibilities include overseeing the Clinical Quality data infrastructure, data quality, data acquisition, data expansion, pursuing the highest value use cases, and implementing in an organized, timely, and effective manner. As dQM depends on timely, standardized, and complete clinical data, this role is essential to translate strategic quality goals into actionable partnerships with external provider organizations. It ensures the business has the right contractual, operational, and relationship frameworks to support digital data acquisition at scale—particularly in Value Based Program (VBP) aligned environments.
Key Functions:
Data Strategy & Delivery
- Develop multi-year data roadmap that allows Cigna to meet digital quality measurement (dQM) regulatory objectives
- Drive the delivery of the clinical quality data strategy, ensuring that development is occurring on time and within budget
- Secure funding to achieve the priority outcomes needed corresponding with the roadmap timeline
- Prioritize data acquisition and vendor strategy based on cost/benefit analysis and provide recommendations on vendor/tool usage to close data gaps
- Partner with architecture and engineering teams to ensure data platforms and infrastructure support business priorities and long-term strategy
- Advocate for scalable, flexible solutions that enable future growth and innovation
- Translate business objectives into strategic data capabilities, enabling the matrixed cross functional team to prioritize investments that directly support digital transformation
Data Product Ownership
- Function as the business product owner for the Clinical Quality data product
- Coordinate with technical data product delivery teams to build enterprise data product that will house clinical quality data
- Drive the adoption and transition of reporting and analysis to pull from new data product
Contractual Data Enablement
- Evaluate existing vendor and provider agreements to assess if they support digital clinical data capture.
- Provide recommendations for which vendors are strategic, and which vendors can be sunset because of building direct connections to source data
- Partner with the contracting team to embed SLAs, FHIR/API expectations, and documentation standards.
Data Quality Liaison
- Coordinate with analytics and validation teams to share discrepancies with providers (e.g., missing codes, delayed data, incomplete payloads).
- Establish a feedback loop with providers to close data gaps and improve compliance.
- Ensure development of data products and data feeds are well governed, have data stewardship, and meet compliance standards.
Support for Value-Based Care (VBP)
- Align provider-facing data expectations with VBP quality metrics and scorecards.
- Ensure providers understand which clinical actions and documentation impact quality scores and financial incentives.
Leadership /Mentorship
- Manage team consisting of data governance and data stewardship roles
- Provide development opportunities and drive upskilling plan
- Network and build connections with partner teams such as Data Engineering, Interoperability, Clinical Initiatives, and HEDIS Operations
Qualifications:
- Master’s degree preferred, or Bachelor’s degree with 10+ years’ experience in data project delivery
- 7+ years professional work experience in:
- Driving the data strategy and data product development at a Fortune 50 or larger size company
- Driving multi-million dollar investments and navigating enterprise portfolio funding process
- Data Governance, Data Management, Data Quality, or Process Improvement practices
- Healthcare payer data products and processes
- Clinical data standards and operations
- Clinical terminology, concepts, business processes and data management lifecycle related to Health Services, Care Management, and Health / Wellness programs (e.g., utilization management, case management, demand management, medical review, care plans, health care coaching, incentives, etc.)
- Health Profiles / History (e.g., health assessments, electronic medical records, etc.)
- Health Measurement (population health, evidence-based medicine, episodes of care, gaps in care, health risk scores, next best actions, HEDIS, NCQA, performance guarantees, etc.)
- Healthcare Interoperability, HIE / EDI data exchange, and EMR standards and solutions (e.g., HL7, FHIR, OHDSI / OMOP, Epic, Arcadia, etc.)
- Strong communications skills (verbal, listening, written, and presentation) with management teams and peer groups
- Strong leadership skills to motivate others to achieve goals and inspire change; ability to engage business and data stakeholders to resolve questions or issues; demonstrate ability to create professional relationships and effectively influence cross-functional teams
- Must have the ability to manage multiple and sometimes competing priorities in a fast-paced environment; ability to organize and develop project plans supporting near and long-range goals and actions; able to strategize across complex, cross-functional projects and initiatives
- Must have strong analytical and problem-solving capabilities
- Must be able to think creatively, innovate and flex where needed - quick/adaptive learner and collaborator/team player
- Self-motivated and able to function with minimal direction
- Intermediate to Advanced proficiency in the implementation and management of data analysis and data governance tools / solutions (e.g., SQL, SAS, TOAD, Python, Hadoop, Teradata, Databricks, Snowflake, Tableau, Collibra, Infosphere, Alation, etc.)
- Project management and Six Sigma skills are a plus
- Experience in Agile Methodology and tools (e.g., Jira, Rally, etc.)
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.
For this position, we anticipate offering an annual salary of 130,400 - 217,400 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 plan.
We want you to be healthy, balanced, and feel secure. That’s why 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) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group.
About The Cigna Group
Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. 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: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com 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.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.