Senior Director, Coverage Review Client Operations

The Cigna Group

Senior Director overseeing Coverage Review operations for Evernorth Health Services. Leading regulatory compliance and operational performance while managing complex client-facing operations.

Posted 4/23/2026full-timeBloomfield • Connecticut • 🇺🇸 United StatesSeniorWebsite

About the role

Key responsibilities & impact

Serve as the accountable executive leader for Coverage Review Client Operations supporting Account Management and client delivery models.
Establish enterprise standards for client‑facing operational performance, escalation management, and issue prevention.
Translate client, regulatory, and market needs into enterprise operational strategies and multi‑year roadmaps.
Maintain end‑to‑end operational compliance with federal and state regulatory requirements, with deep focus on Medicare and CMS standards.
Provide executive oversight of Medicare coverage review activities, including appeals, reconsiderations, and Independent Review Entity (IRE) support.
Define governance, controls, and monitoring frameworks to ensure audit readiness, risk mitigation, and sustained compliance.
Oversee Coverage Review implementations for new and existing clients, ensuring operational readiness, compliant configuration, and cross‑functional alignment.
Lead PA research and related enablement functions to support consistent, evidence‑based, and policy‑aligned decision‑making at scale.
Drive operational excellence through performance management, KPI oversight, continuous improvement, and sustainable operating models.
Lead and develop a multi‑layer leadership team, building accountability, succession readiness, and future enterprise leaders.

Requirements

What you’ll need

Bachelor’s degree required; advanced degree (MBA, MHA, MPH, PharmD, or similar) preferred.
12+ years of progressive experience in healthcare operations, coverage review, prior authorization, or related payer functions, including leadership roles within large, complex, and highly regulated organizations.
Deep expertise in Medicare coverage review, appeals, and Independent Review Entity (IRE) processes, with strong knowledge of CMS and broader regulatory requirements.
Demonstrated ability to partner with Account Management and lead client‑facing operational models in regulated environments.
Proven success leading enterprise implementations, operational transformations, and continuous improvement initiatives.
Executive presence with strong written and verbal communication skills and the ability to influence decision‑making across a matrixed enterprise.
Strong analytical judgment and decision‑making capability in ambiguous, high‑risk, and high‑visibility environments.
Experience supporting PBM, utilization management, or prior authorization operations and partnering with Product and Technology teams to operationalize new capabilities.

Benefits

Comp & perks

Health insurance
Professional development opportunities
Flexible working arrangements

ATS Keywords

✓ Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

healthcare operationscoverage reviewprior authorizationMedicare coverage reviewappealsIndependent Review Entity (IRE) processesoperational transformationscontinuous improvementKPI oversightoperational compliance

Soft Skills

executive presencewritten communicationverbal communicationinfluence decision-makinganalytical judgmentdecision-making capabilityleadershipaccountabilitysuccession readinesscross-functional alignment

Certifications

Bachelor's degreeMBAMHAMPHPharmD