RNorLPN-NurseQualityClinicalManagementLeadAnalyst

**Position Scope** The purpose of this position is to support the Quality Management Program through multiple clinical, service and operational activities by driving continuous quality improvement in patient safety and improvements in efficiency and effectiveness; and by supporting activities to measure clinical programs and service processes and outcomes. This position can be a Cigna Work at Home or in office and requires minimal domestic travel of up to 5% for internal meetings, accreditation or quality components of state regulatory audits related to customer experience. This position reports to the Quality Clinical Management Manager. **Major Responsibilities** Reviews, investigates and monitors assigned clinical and quality activities such as Quality of Care Complaints and Adverse Events, which may include follow up with internal medical executives/directors, external health care professionals/facilities, and individual customers as well as presentation to the Peer Review Committees (in accordance with National Policies and Procedures). Implements partnerships and participates in initiatives focusing on reducing health disparities. Collects and analyzes data, develops studies and reports to workgroups and supports quality committee activities. Performs review of clinical metrics and data and monitors for patient safety including continuity and coordination of care. Supports provider performance measurement activities such as generating and reviewing reports and medical record reviews. Define and document policies, standard operating procedures, workflows and processes. Participates and leads special workgroups and process improvement teams as needed. Supports regulatory compliance activities as needed. **Outcomes Expected** * Resolve Quality of Care and Adverse Event cases and send resolution letters within required timeframes 95% of the time. * 100% of QM Work plan activities, and policies and procedures will be completed as scheduled and meet accreditation re