Senior Advisor, Care Model & Payment Innovation

Responsibilities

• Build and manage a pipeline of partnership and model opportunities across pharmacy, specialty, provider, employer, and health plan stakeholders
• Assess market dynamics, competitive positioning, regulatory considerations, operational feasibility, and data requirements to inform prioritization
• Translate client needs and affordability opportunities into actionable innovation concepts
• Identify and assess external partnership opportunities with intermediaries, high‑performing providers, enablement platforms, pharmacies, pharmaceutical manufacturers, and specialty care partners
• Support relationship‑building strategies that strengthen Cigna Healthcare and Evernorth’s position with key market intermediaries and provider partners in support of payment and care model innovation
• Contribute to partnership models that align incentives, improve outcomes, and support total cost of care management
• Support development of partnership and payment models with appropriate attention to compliance, regulatory, legal, and policy considerations
• Coordinate with Compliance, Legal, Data & Analytics, and business stakeholders to identify risks, constraints, required guardrails, and model assumptions early in design
• Ensure innovation concepts account for manufacturer interaction requirements, pharmacy and PBM dynamics, data use considerations, and applicable market rules
• Frame trade‐offs and escalation needs clearly for leadership decision‑making
• Support the design of advanced care delivery models and payment structures across primary care, specialty care, pharmacy‑enabled care, and value‑based prescribing opportunities
• Partner with Data & Analytics to model, evaluate, and prioritize care model and payment innovation opportunities, including opportunity sizing, target populations, performance assumptions, and evaluation metrics
• Translate clinical, operational, financial, data, and market insights into structured frameworks and executive‑ready recommendations
• Shape pilots by defining hypotheses, target populations, stakeholder roles, metrics, and evaluation approaches
• Support high‑performing provider strategies that differentiate provider engagement, incentives, enablement, and performance expectations
• Define strategy and roadmaps to scale successful payment and care models sustainably
• Align stakeholders across pharmaceutical manufacturer strategy, pharmacies, PBMs, specialty pharmacy, providers, employers, and health plans
• Translate strategy into implementation pathways, sequencing, governance needs, and execution decision points
• Structure ambiguous problems and develop decision‑ready recommendations for senior leaders
• Synthesize inputs into clear strategic options, trade‑offs, risks, and recommended next steps
• Develop executive‑level materials, leadership briefings, and Board‑ready narratives that connect strategy, partnership value, compliance considerations, and execution readiness

• Bachelor’s degree or relevant experience required; advanced degree preferred
• 5–7 plus years of relevant healthcare, strategy, consulting, pharmacy, managed care, provider, PBM, or life sciences experience
• Experience with value‑based care, alternative payment models, pharmacy strategy, specialty care, or outcomes‑based contracting preferred
• Strong problem‑solving, stakeholder management, and executive communication skills
• Ability to operate effectively across complex, matrixed, and regulated healthcare environments
• Ability to partner with Data & Analytics teams to model opportunities, define assumptions, evaluate performance, and translate findings into strategic recommendations
• Strategic thinking and structured problem solving
• Partnership orientation and relationship‑building capability
• Market awareness across pharmacy, PBM, specialty pharmacy, provider, employer, and health plan stakeholders
• Compliance‑aware judgment and risk framing
• Data‑informed opportunity modeling, evaluation, and prioritization
• Pipeline development and opportunity prioritization
• Ability to operate in complex, cross‑functional environments
• Executive presence and communication
• Conceiving of and executing complex projects on a clear and defined timeline