Utilization Manager Jobs in Enfield, CT (NOW HIRING)

The enterprise clinical team is reimagining its global talent model to support The Cigna Group's Strategic Optimization Program (SOP). This program focuses on building clinical operations that are scalable, high quality, and efficient. The Principal, Global Talent Hub Clinical Lead, is responsible for turning the clinical global talent strategy into action. This includes building compliant clinical capabilities, transitioning roles based on regulatory and contract requirements, and delivering long-term value while maintaining quality, patient safety, and clinical integrity. This role offers a unique opportunity to help build a global clinical delivery model from the ground up and shape how clinical work is delivered safely and in compliance at scale. This position reports to the Managing Director, Enterprise Clinical Strategy and Operations.

Responsibilities

• Translate enterprise clinical global talent strategy into execution through structured, wave-based implementation plans that deliver measurable value across cost, quality, and scalability.

• Partner across Clinical, Enterprise Strategy, Global Talent, and external vendors to define and evolve the global clinical operating model, including scope such as utilization management, case management, pharmacy support, and administrative services.

• Lead clinical role assessment and governance processes to determine optimal role location, ensuring alignment with licensure requirements, regulatory standards, accreditation needs, and client contract obligations.

• Establish clear guardrails and scope boundaries by identifying which clinical roles are appropriate for globalization and documenting rationale to support decision-making and compliance reviews.

• Design and lead clinical transition planning, including vendor engagement, operating model selection (BPO, captive, or hybrid), and readiness assessments to support safe, compliant implementation.

• Ensure transition designs account for clinical-specific requirements such as credentialing, licensure, supervision structures, and enhanced quality and audit checkpoints.

• Build and scale global clinical and non-clinical teams by partnering with Talent Acquisition and HR to deliver recruiting, credentialing, and onboarding pipelines aligned to market supply and regulatory expectations.

• Establish clinical leadership models, including supervision layers and on-site leadership roles, to support safe delivery and clinical governance at scale.

• Implement end-to-end clinical process ownership with embedded quality metrics, productivity measures, service-level agreements, and patient safety indicators to ensure consistent outcomes.

• Ensure readiness for audits, accreditation, and client assurance processes, including data privacy, regulatory adherence, and quality performance standards.

• Design governance structures and value tracking methodologies that measure role transitions, cost-to-serve improvements, time-to-proficiency, and clinical quality outcomes.

• Proactively identify and escalate risks related to regulatory compliance, workforce readiness, and clinical quality, enabling timely resolution and continuous improvement.

• Drive stakeholder alignment and change management across clinical leaders, business units, Legal, Compliance, and Enterprise stakeholders to support successful global hub implementation.

• Develop and deliver executive-level communications and presentations that clearly articulate strategy, progress, and value realization of the clinical global talent model.

Qualifications

Required

• 8+ years of experience in healthcare, clinical operations, transformation, or delivery roles.

• Demonstrated experience leading or supporting global clinical delivery models, including GCC or GBS environments.

• Strong understanding of clinical regulatory frameworks, licensure requirements, and compliance standards.

• Proven ability to lead complex, cross-functional initiatives and end-to-end clinical transitions in dynamic environments.

• Experience working with core clinical functions such as utilization management, case management, or pharmacy support.

• Ability to balance competing priorities across cost, quality, speed, and regulatory considerations while driving decision-making.

Preferred

• 12+ years of experience in healthcare, clinical operations, transformation, or delivery roles.

• Experience supporting or building global clinical hubs in regions such as India or the Philippines.

• Familiarity with vendor delivery models, including BPO, captive, and hybrid operating structures.

• Understanding of clinical workforce economics, including productivity, attrition, and time-to-proficiency metrics.

• Experience developing partnerships with academic institutions, licensing bodies, or workforce pipeline programs.

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 141,500 - 235,900 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 and long term incentive 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, paid holidays, and leaves of absence. For more details on our employee benefits programs, click here.

About The Cigna Group

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.

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.