The Chief Medical Officer (CMO) for Evernorth will serve as the senior physician leader responsible for advancing and supporting clinical strategy across Evernorth’s diverse businesses, in collaboration with the business leaders. This includes Express Scripts and Evernorth Health Services pharmacy and care delivery businesses. This role is designed for an innovative physician executive with deep expertise in pharmacy, PBMs, specialty drugs, disease management, technology and AI, external and government affairs.
Reporting to the Chief Medical Officer of The Cigna Group and partnering closely with Evernorth senior P+L and clinical product and operations leaders, the CMO will collaborate with key leaders to shape Evernorth’s clinical vision, drive strategic initiatives to enhance quality, affordability and innovation and advance the organization’s clinical value proposition.
The CMO will also serve as an external-facing clinical leader, representing Evernorth to clients (employers and health plans), providers, key external partners and regulators. This role will also entail bringing market, client, provider, pharma, government and industry perspectives into Evernorth’s business priorities, product innovation, and growth agenda.
This role also provides oversight of key areas of clinical operations, including Pharmacy Prior Authorization (PA) operations. This will include both maintaining the highest level of operations, clinical integrity and patient experience, as well as advancing Enterprise PA transformation efforts, ensuring PA priorities are integrated with The Cigna Group’s clinical strategy.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Clinical Strategy and Messaging
- Partner with senior Evernorth business leadership to collaborate in evolving Evernorth’s clinical narrative and strategic direction, supported by a small team of project managers and strategists.
- Drive the advancement of strategic clinical work across relevant Evernorth businesses.
- Serve as liaison to bring external client, market, provider and clinical perspectives to internal product, business and enterprise partners, helping inform differentiated clinical solution development and delivery across Evernorth.
- Connect the clinical community across relevant Evernorth businesses and functions, fostering collaboration, alignment, clinical excellence, education, thought leadership and subject matter expertise on emerging healthcare trends and enterprise priorities.
Market Clinical Leadership
- Build and strengthen strategic account relationships with Sales, Product, Account Management, client strategy and business leaders, serving as a senior clinical executive in client leadership interactions related to strategic direction, clinical priorities and evolving business needs. This includes a focus on both new sales and maintenance and bolstering of existing client relationships.
- Provide strategic clinical and operational input into proposals, finalist presentations and operational execution processes to support business growth, client outcomes, differentiated value propositions and win rates.
- Provide direct clinical leadership and oversight for Pharmacy Utilization Management and Prior Authorization work.
- Ensure innovative solutions, quality outcomes, message integrity and evidence-based clinical content are incorporated into proposals and clearly articulated in finalist client presentations.
Provider Partnerships
- Collaborate with key stakeholders to advance provider relationships and integrated care models, with a focus on both the specialty provider community, as well as general providers interacting with Express Scripts.
- Develop and support evolving sales and engagement strategy for specialty providers/prescribers.
- Establish and maintain executive-level strategic relationships with senior clinical, pharmacy, provider, client and business leaders, including leaders responsible for formulary strategy, benefit design, clinical program direction and care delivery priorities.
- Partner with cross-functional senior leaders across clinical, product, market, client strategy, operations and business organizations to ensure clinical solutions and strategies are developed, aligned, supported.
Government Affairs, Thought Leadership and Clinical Face-to-Market
- Collaborate with Evernorth business leadership to drive Evernorth’s clinical engagement in government-related initiatives and serve as a prominent clinical voice in state and federal government affairs interactions.
- Represent Evernorth externally with clients, providers, industry partners, community stakeholders and policy-oriented forums to stay informed on, contribute to and help shape emerging clinical and policy developments related to pharmacy.
- Act as a clinical face outside the organization to help inform and validate decision-making, provide clinical insight in support of the business development lifecycle and strengthen Evernorth’s credibility as a trusted partner in pharmacy.
- Foster external collaborations that enhance care delivery, advance clinical innovation and contribute to relevant public policy and industry discussions.
Clinical Operations Oversight and Prior Authorization Transformation
- Partner with internal teams to monitor clinical and operational performance in pharmacy UM, resolve complex cases and issues, and continuously improve processes that safeguard patient outcomes, promote quality and compliance, and strengthen operational integrity.
- Ensure alignment with existing quality programs and operational excellence across pharmacy and nursing services.
- Oversee Enterprise PA transformation efforts, ensuring related work is innovative and grounded in clinical integrity, quality, safety, evidence-based practice and operational excellence.
Clinical Product Development and Innovation
- Guide design and delivery of innovative Evernorth pharmacy-related clinical solutions, including next-generation pharmacy services, GLP-1 programs and rural care models, supported by a small group of subject matter experts.
- Provide clinical strategic input and leadership in identifying new growth opportunities, emerging clinical innovations and strategic initiatives across Evernorth and Express Scripts’ pharmacy and specialty businesses.
- Partner with technology and innovation leadership to ensure automation, artificial intelligence and other technological advancements are advanced with clinical integrity while promoting clinical quality and safety.
- Advance and mature clinical programs in expense-constrained environments.
Enterprise Partnership and Influence
- Serve as a critical partner to Evernorth leadership with matrix accountability to Evernorth business leaders, influencing enterprise-wide clinical priorities and fostering collaboration with pharmacy and medical leaders across the organization.
- Leverage influence, vision and executive command to drive transformation within Evernorth and across the broader enterprise, demonstrating the clinical needs of clients, patients and the business.
EXPERIENCE, KNOWLEDGE, EDUCATION, AND OTHER REQUIREMENTS
- Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) required. MBA and/or relevant management consulting experience preferred.
- 15+ years of clinical and clinical leadership experience, ideally with background in specialty pharmacy, pharmacy benefits management, pharmacy managed care, pharmacy retail or industry setting
- Experience, training and expertise to provide clinical leadership and inform strategy across a broad range of therapeutic categories, clinical programs, products and emerging pharmacy trend areas.
- Demonstrated experience leading and scaling complex clinical operations across multi-site, regional, or national healthcare organizations.
- Demonstrated initiative with proven ability to influence business strategies in support of major organizational and market initiatives, work cross-functionally with various departments and set priorities.
- Demonstrated ability to think strategically, anticipate future consequences and trends, and incorporate them into short-term and long-term organizational plans.
- Inspirational, compelling leader capable of communicating a vision to external and internal constituents and commanding respect and enthusiasm.
- Ability to build strong relationships with executive members of client organizations, external partners and senior internal stakeholders.
- Enterprise thinker with proven ability to influence across a matrix environment and build strong relationships across all levels of the organization.
- Demonstrated ability to simplify clinical program complexity into clear, measurable value.
- Strong persuasion skills and effective communicator; able to create and communicate a compelling vision internally and externally.
- Able to act and react as necessary, even when limited information is available; comfortable taking charge of complex situations, overcoming resistance and taking necessary stands when appropriate.
- Strategic and client-focused mindset with the ability to balance clinical excellence, business objectives, patient outcomes and market opportunities while effectively influencing stakeholders across a complex matrix organization.
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 390,100 - 585,100 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, .
