Medical Director - Clinical Strategy

Medical Director Clinical Strategy

Role Summary

The Clinical Strategy Leader, will report to the Associate Chief Medical Officer for Clinical Product and Solution Design and support the development and execution of Cigna Healthcare’s strategy for members with high-risk and complex care needs. This includes high-risk members with complex chronic conditions, oncology needs, high drug spend, serious illness, specialty pharmacy needs, and other populations requiring advanced clinical navigation and case management support.

This leader will help translate clinical, business, and affordability priorities into actionable strategies, scalable clinical programs, digital and AI-enabled solutions, and measurable execution plans. The role will partner across Clinical, Product, Strategy, Technology, Data, Operations, Pharmacy, Finance, and market-facing teams to identify priority opportunities, design differentiated solutions, develop business cases, support implementation, and measure impact.

A core focus of the role will be leading the development of digital and AI-enabled solutions for high-risk members, including AI agents, advanced segmentation, proactive member engagement tools, digital navigation capabilities, clinical workflow support, and technology-enabled case management models.

This role will be critical to positioning Cigna Healthcare as a market-leading clinical organization by translating complex care needs into differentiated scalable solutions that improve outcomes, affordability, and member experience.

The ideal candidate will be a strategic, execution-oriented health care leader who can combine clinical insight, business acumen, analytics, digital fluency, and strong cross-functional leadership to improve health outcomes, member experience, affordability, and enterprise value.

Responsibilities

Support development and execution of Cigna Healthcare’s strategy for high-risk and members with complex care needs, including oncology, high drug spend, serious illness, specialty pharmacy needs, and complex chronic conditions.

Translate clinical and business priorities into strategic roadmaps, business cases, implementation plans, and measurable performance goals.

Lead the design of scalable clinical programs for high-risk and complex populations, including identification, engagement, navigation, escalation, care coordination, and longitudinal support.

Lead development of digital and AI-enabled solutions for high-risk members, including AI agents, advanced segmentation, proactive outreach, member-facing navigation, clinician workflow support, and next-generation case management capabilities.

Partner with Product, Technology, Data, Clinical Operations, Pharmacy, Analytics, Finance, and market-facing teams to identify priority use cases, define requirements, and support execution through implementation.

Use data, analytics, claims insights, clinical and pharmacy trends, operational performance, and client needs to identify opportunities and prioritize initiatives.

Improve case management and complex care models, including structured case review processes, high-risk case management, and targeted interventions for priority populations.

Develop performance measurement frameworks, including KPIs related to clinical outcomes, affordability, member experience, engagement, operational efficiency, clinician adoption, and client value.

Drive process improvement and operating model enhancements to improve scalability, consistency, and execution discipline.

Align stakeholders across a matrixed organization to establish shared priorities and drive improved business outcomes.

Prepare executive-ready strategy documents, updates, recommendations, and decision materials for senior leadership.

Lead cross-functional teams and workgroups through complex initiatives, fostering accountability and collaboration.

Bring an outside-in perspective on clinical innovation, digital health, AI-enabled care models, oncology, specialty pharmacy, high-cost therapies, GLP-1s, gene therapy, and other emerging areas relevant to clinical product strategy.

Help ensure digital, AI-enabled, and clinical solutions are clinically sound, member-centered, operationally feasible, financially grounded, measurable, and aligned with responsible innovation principles.

Qualifications

Required

• Active and unrestricted Medical License in State (MD/DO)
• Current Board Certification in an ABMS or AOA recognized specialty
• Minimum 3 years of clinical practice experience

Essentials

Experience in strategy development and implementation for health care-related organizations, including payer, provider, pharmacy, clinical services, health services, consulting, digital health, or related sectors.

Experience developing clinical programs and driving successful execution from concept through implementation, adoption, and measurable outcomes.

Strong business and/or consulting experience, including ability to structure complex problems, synthesize insights, develop recommendations, and translate strategy into action.

Solid business and financial acumen, with ability to connect clinical initiatives to affordability, value creation, operational performance, client needs, and enterprise impact.

Experience using analytics, data, and performance insights to identify opportunities, shape strategy, guide decision-making, and measure outcomes.

Experience leading teams or cross-functional workgroups to execute complex projects in a matrixed environment.

Process improvement experience, including ability to improve workflows, operating models, execution processes, and scalable program delivery.

Ability to influence stakeholders, establish alignment, and drive improved clinical, operational, financial, and business outcomes.

Strong executive communication skills, including ability to translate complex clinical, operational, financial, analytical, and technical topics into clear, concise, leadership-ready materials.

Digital and AI fluency, including ability to partner with Product, Technology, Data, and Clinical teams to develop AI-enabled and digital solutions for high-cost claimants, including AI agents, advanced segmentation, proactive engagement tools, and technology-enabled case management workflows.

Preferred

Experience in payer strategy, care management, complex care, oncology, specialty pharmacy, high-cost therapies, serious illness care, chronic condition management, value-based care, or clinical product design.

Experience with digital health, AI-enabled clinical solutions, AI agents, predictive analytics, intelligent workflow design, member engagement tools, or technology-enabled care navigation.

Experience working in a national health plan, health services organization, clinical operations environment, health care consulting firm, provider organization, pharmacy organization, or digital health company.

Experience developing executive-level business cases, investment recommendations, operating models, or transformation roadmaps for clinical 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 212,600 - 354,300 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.