RN Health Services Manager - Cigna - Remote

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.

The Clinical Waste & Abuse (CWA) Complex Claim Program leader oversees pre- and post-pay medical record reviews to support accurate coding, billing, medical necessity determinations, and coverage decisions in alignment with the benefit plan and Cigna Medical and Reimbursement Policies. This leader manages and develops a team of Registered Nurses and drives a quality, cost-effective approach to high-cost claim review operations.

Hire, onboard, and retain staff; foster engagement and accountability. Monitor daily inventory, capacity, and financial performance to ensure alignment with goals. Serve as the subject matter expert for clinical pre-pay requests and key matrix partner needs. Coach the team on workflows, processes, and tools; reinforce best practices and quality standards. Track service metrics and quality results; review work regularly and take action to address trends and gaps. Set clear objectives and performance expectations for direct reports aligned to operational priorities. Provide ongoing performance coaching, career development support, and feedback; support talent planning and succession. Communicate effectively with stakeholders across the Complex Claim Unit, including Medical Directors and matrix partners.