Program Management Senior Advisor - Evernorth - Hybrid

Key Responsibilities:


* Project Management focused on strategically designed initiatives, supporting the full project scope and assessment to identify Health Management impacts end to end including the identification of any gaps, barriers and other issues that may result in overall outcomes of the projects utilizing 278 EDI logic.


* Expectations include: design, development and management of the project workstream that encompasses the EDI needed to meet and exceed overall Health Improvement goals, including but not limited to: Clinical value metrics to achieve Total Medical Cost savings targets, implement pilots/projects, improve/ensure Quality improvement, operational efficiency, and effectiveness via utilization of appropriate project management processes and tools: all of which result in measurable improvement in overall customer health care, professional experience, customer engagement and client partner satisfaction with delivery of the services purchased.


* Support and manage and assessment of all assigned key components of a project that utilized 278 EDI logic and in the support of development, evaluation and implementation of new or changing health improvement products, programs, business systems, service delivery models and tools.


* Support the enhancement & development of operational workflows changes for all Health Management projects with program impacts including UM, CM, Intake and working with those matrix partners and dependencies.


* Demonstrate the ability to manage multiple complex time sensitive initiatives with numerous internal partners designed to deliver targeted outcomes and health improvements (Enterprise, Multi-vertical)


* Define and advise on all business and system requirements for assigned projects from an end-to-end perspective.


* Lead implementation via successful project management of changes within Health Management (organizational transitions, etc.) partnering with appropriate vertical SME and/or PM and eviCore teams.


* Ability to work in partnership with Product, Quality, Program Development, Compliance, eviCore, Gateway, IBOR, IT, R&S, Pharmacy teams as well as all Operational SME's for each impacted area.


* Effectively manage daily data and proactive assessment of identified trends/issues and gaps.


* Effectively communicate data outcomes to the appropriate business owner with details/requirements and identify areas of business impacted.


* Defines the requirements for needed system modifications and give relative and timely input regarding the prioritization of requests for assigned business areas and projects.


* Collaborates and aligns with Product, Clinical Operations, Service Operations, Pharmacy, Claims, Analytics, Network, IT and many other key matrix partners.


* Manage scenario and testing results related to 278 EDI.


* Post implementation of processes utilizing EDI transmissions with responsibilities to identify trends/gaps/outcomes.
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