• CIGNA
  • $54,110.00 -77,570.00/year*
  • Philadelphia , PA
  • Customer Service/Call Center
  • Full-Time
  • 1103 Market St

It's fun to work in a company where people truly BELIEVE in what they are doing!

We're committed to bringing passion and customer focus to the business.

Position Summary:

This position has responsibility for planning, directing, and managing the day-to-day operation of the PreCertification team. The Health Services Manager is responsible for leadership and management of PreCertification supervisors and their staff. The Health Service Manager is responsible for team attainment of quality, production, and timeliness goals, and ensures excellent customer satisfaction for both internal and external customers. The Health Services Manager has the ability to review, investigate, and respond to external and internal inquires/complaints. Provides guidance and acts as a mentor or coach for Supervisors. The manager leads or participates in projects/assignments, interfacing with multiple business partners across the organization.

Essential Duties and Responsibilities:

* Supervision of direct reports who are responsible for management of staff, service delivery, and associated performance requirements for the Cigna- HealthSpring PreCertification team.
* Participates in national teams and committees, as needed.
* Communicates with all levels of staff within Shared Services, matrix partners; externally with customers, medical providers, vendors, claims payors, and insurance professionals.
* Reports to the VP, Clinical Operations
* Build solid working relationships with staff, customers, other key functional areas and providers.
* Establish unit objectives and determine performance standards and goals for direct reports that are consistent with customer requirements and operational objectives for a service delivery environment.
* Support and monitor the PreCertification and assure quality of performance against QI standards to promote optimal service delivery and ensure accurate statistical data and reports. Implement appropriate corrective action as necessary.
* Lead in interviewing, hiring, and retaining qualified professional staff.
* Evaluate staff performance, encourage new skill development, motivate staff and assist employees in establishing appropriate career tracts. Participate in development of supervisors and high potentials with the organization.
* Initiate action regarding new policies, procedures and programs to ensure continual improvements in effectiveness, quality, results, profitability, productivity and efficiency of operation.
* Maintain expert knowledge of all product lines, directs the implementation of pilots, new products, enhancements and serve as a field resource for product development and management. This includes the achievement of customer performance guarantees
* Support diversity by promoting diversity in selection process, employee retention, customer initiatives, and developmental plan for high potentials.
* Works with Resource Manager to schedule staff to achieve services levels. This includes understanding and support of tools and monitoring systems.
* Support financial and capacity plans and manage the results to meet the goals.
* Support telecommuting initiatives, including remote telecommuting staff, as applicable
* Assure that services are delivered according to Policy and Procedure, Product and Quality Assurance standards, and URAC Accreditation standards.
* Responsible for oversight of the annual and semi-annual performance evaluation process, individual discussion and feedback, and compensation for all team members.
* Ensures that all key metrics and financial targets are achieved.
* Demonstrates leadership in sensitivity to culturally diverse situations with staff, matrix partners, clients and customers.

Qualifications:

* Bachelor's degree; Master's degree preferred in a related field or related experience
* Minimum of five years experience in leading a health services team; operations background
* Managed care experience a plus
* Exceptional time management skills
* Experience in Utilization Management, Case Management, or Call Center environment
* Demonstrated strong organizational and leadership skills
* Strong interpersonal and communication skills
* Demonstrates problem-solving and analytical skills.
* Knowledge of utilization or case management, cost containment services, managed care, insurance coverage, and financial management
* Ability to operate personal computer, proficient with Microsoft office products, call center software, and a variety of software.
* Demonstrated ability to act as a change agent in a fast pace business environment
* Ability to build solid working relationships with staff, matrix partners, customers and providers
* Demonstrated process improvement experience

Knowledge, Skills, Abilities Required:

* Excellent analytical and organizational skills required.
* Excellent oral and written communications skills.
* Excellent interpersonal and communications skills with nursing staff, physicians, nurse practitioners and other health workers involved in the care of a member
* Extensive knowledge of medical management processes including authorization rules and contracting methodology.
* Ability to meet deadlines and manage multiple priorities, and effectively adapt and respond to complex, fast-paced, rapidly growing, and results-oriented environments
* Ability to make decisions on what needs to be done based on clearly established guidelines
* Able to work in a dynamic, fast-paced team environment and to promote team concepts
* Experience managing process workflows.
* Ability to develop statistical measures for the purposes of evaluating process efficiencies.
* Ability to present process performance information in table, chart, and dashboard formats.
* Excellent presentation skills and ability to communicate in both written and oral formats.

Computer Skills:

* Strong knowledge of Microsoft Office products including Excel, PowerPoint, Word, and Access.
* Ability to develop training materials using E-learning software.

Qualified applicants will be considered without regard to race, color, age, disability, sex (including pregnancy), childbirth 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 an accommodation based on your physical or mental disability please email: ...@cigna.com. Do not email ...@cigna.com for an update on your application or to provide your resume as you will not receive a response.
Associated topics: call center manager, customer service manager, director, expertise, guidance, lead, operations, operations manager, product support, telephone

* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

Launch your career - Upload your resume now!

Upload your resume

Loading some great jobs for you...