Medical Director

🕒 5 days ago

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The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1982

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare Insurance • Pharmaceuticals

The Cigna Group is a global health company committed to improving the health and vitality of its clients, customers, and patients. With its two divisions, Cigna Healthcare and Evernorth Health Services, the company focuses on enhancing quality of life through healthcare services and pharmacy benefits management. The Cigna Group is dedicated to ethical practices in healthcare and artificial intelligence, and strives to create positive change in the healthcare system. It also emphasizes its Environmental, Social, and Governance (ESG) responsibilities, aiming to impact health equity and foster innovation in healthcare delivery.

📋 Description

• Provide timely expert medical review of medical necessity requests for clinical services (including post-acute care) • Render a clinical opinion about the medical service under review, including post-decision reviews • Provide timely and collegial peer-to-peer discussions with treating physicians to clarify clinical information and to explain review outcome decisions • Document all actions related to clinical review sessions and attest to review qualifications as required • Participate in rounds as necessary when providing coverage for other Medical Directors • Maintain necessary credentials and immediately inform eviCore of any adverse actions relating to medical licenses and/or board certifications • Support the review of eviCore clinical guidelines • Support and communicate eviCore policies and procedures to the provider community • Testify at ALJ Hearings when your cases are being appealed • Assist with staff educational training and in-service programs and serve as a clinical resource for eviCore staff • Serve as a Subject Matter Expert when Medical Directors and/or Senior Medical Directors are unavailable • Participate in all required educational and quality improvement activities and maintain passing scores in all assessments • Assist in reviewing case determinations from clients responding to a provider or member complaint • Maintain necessary credentials and immediately inform eviCore of any adverse actions relating to medical licenses and/or board certifications

🎯 Requirements

• M.D. or D.O. degree from accredited institution • Minimum of five (5) years of clinical practice experience after completion of all graduate medical education training, including residency and fellowship (when applicable) • Active board certification, primary care specialties (Family Medicine, Internal Medicine, Emergency Medicine) preferred • Active unrestricted license to practice medicine in a state or territory of the United States as a utilization review doctor of medicine or doctor of osteopathic medicine • Knowledge of applicable state and federal laws, URAC and NCQA standards, and utilization management • Must be able to type 30 WPM • Proficient computer skills and knowledge of Microsoft Office applications

🏖️ Benefits

• medical, vision, dental, and well-being and behavioral health programs • 401(k) • company paid life insurance • tuition reimbursement • a minimum of 18 days of paid time off per year • paid holidays