RN Clinical Quality Sustainment Coach - Evernorth Health Services - Remote
Hours: Must be able to Work between 8:00 a.m.-5:30 p.m. Monday-Friday
Role Summary
Reporting to the Clinical Quality Supervisor, the Clinical Quality Sustainment Coach (QSC) is responsible for performing quality reviews of clinical cases and call recordings within Cigna operational systems. This role delivers direct feedback and coaching to operational front-line staff based on review outcomes to drive quality improvement, consistency, and improved member outcomes. The QSC supports quality analysis and contributes to quality improvement initiatives across Care Solutions, with oversight from leadership.
Responsibilities
Champion Cigna’s Consumer Health Engagement Cultural Beliefs: Customer Strong, Me to We, Own It!, Be Bold, Listen to Advocate, Think It Through.
Serve as a subject matter expert (SME) for assigned clinical and operational areas.
Conduct quality reviews to ensure documentation accuracy and adherence to established quality standards.
Deliver timely, constructive coaching to front-line staff, highlighting successes and opportunities for improvement.
Ensure quality reviews are accurately tracked and documented within designated quality review tools.
Explain and reinforce foundational quality principles and expectations.
Review quality performance data with front-line staff and operational leadership on a monthly basis.
Identify, interpret, and explain department quality metrics.
Exchange quality practices and procedural guidance with matrix partners.
Develop, analyze, and distribute case and call quality review reports.
Collaborate with Readiness & Support (R&S) team members to address trends and improvement opportunities.
Partner with Readiness Team Learning Facilitators to support new hire development and close identified knowledge gaps.
Identify adherence gaps, discrepancies, and error trends; escalate findings and recommendations to operational leadership.
Participate in departmental projects, initiatives, and stretch assignments as assigned.
Qualifications
Active, unrestricted Registered Nurse (RN) license in state of residency
Minimum of three (3) years of nursing experience.
Clinical experience in Case Management
Strong clinical expertise with an understanding of operational workflows, SOPs, policies, and procedures relevant to the assigned area.
Proficiency with Microsoft Word, Excel, SharePoint, WebEx, and Outlook.
Excellent verbal and written communication skills.
Demonstrated coaching skills with the ability to provide positive, constructive feedback.
Ability to recognize and acknowledge individual and team successes.
High emotional intelligence with the ability to quickly build professional, trusting relationships.
Strong analytical skills with the ability to identify trends, action steps, and improvement opportunities.
Ability to assess quality both quantitatively and qualitatively.
Detail-oriented with strong time management, organization, and multitasking skills.
Comfortable raising questions, ideas, and recommendations across all levels of the organization.
Ability to work independently and collaboratively as part of a team.
Acts as a positive role model aligned with Cigna values.
Preferred Qualifications
Experience with clinical and operational systems such as Knowledge Exchange, CCV, OneView, ICMS, TruCare, Verint, or similar platforms.
Client audit experience.
Prior experience as a team lead, subject matter expert, or preceptor.
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 77,300 - 128,800 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.
At The Cigna Group, 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), 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, click here.
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 need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.
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.