Medical Director

🔥 15 hours ago

🇺🇸 United States – Remote

💵 $230.6k - $384.4k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛡️ Insurance

Healthcare • Insurance

The Cigna Group is a global health services company that provides medical, dental, pharmacy, behavioral and supplemental insurance products and benefits to individuals, families, employers, brokers, providers and Medicare beneficiaries. It offers employer-sponsored group plans, individual and family plans (including Open Enrollment offerings), Medicare, international health insurance covering more than 200 countries, and digital member services through the myCigna platform (including telehealth and claims management). Its products are delivered through operating subsidiaries such as Cigna Health and Life Insurance Company and other regional affiliates.

📋 Description

• Lead a team of clinicians supporting utilization management functions and strategic clinical initiatives • Perform benefit-driven medical necessity reviews for coverage, case management, and claims resolution • Apply benefit plan information, federal and state regulations, clinical guidelines, and best-practice principles • Work toward quality outcomes for customers with focus on service and cost • Improve clinical outcomes through daily interactions with health care professionals using education, communication, and negotiation • Balance customer/member needs with business needs while advocating for customers • Participate in all levels of the appeal process as appropriate • Participate in coverage guideline development, medical management projects, quality committees, quality reviews, inter-rater reliability reviews, and quality projects • Mentor or coach Medical Directors and colleagues in quality and performance improvement • Improve health care professional relations through direct communication and evidence-based clinical information • Address customer service issues with leadership support • Investigate and respond to client and regulatory questions • Ensure timely coverage review turnaround, quality outcomes, customer satisfaction, and regulatory/accreditation compliance • Provide clinical insight and management support to functional areas and matrix partners • Direct medical management functions for market, regional, or national programs, including utilization review, quality assurance, case management, medical policy development, and evaluation of new technologies and treatments • Operate as a senior clinician for market, regional, or national programs • Create and implement medical management strategic plans • Support network operations and act as a physician liaison in the community

🎯 Requirements

• Current unrestricted medical license in a US state or territory • Current board certification in an ABMS or AOA recognized specialty (grandfathered by the board or maintained by the MOC program) • Ethical and professional behavior • Minimum of 5 years of clinical practice experience and/or direct patient care beyond residency • Computer competency in word processing, spreadsheet, email, and personal information management programs • Ability to research clinical issues using internet resources • Ability to travel to attend meetings in person as needed • At least three years’ experience in medical management, utilization review and case management in a managed care setting (preferred) • Knowledge of Pharmacy Claims and utilization management (a plus) • Knowledge of Specialty Pharmaceuticals and management (a plus) • Previous experience managing physicians, nurses or employees (a plus, not required) • Knowledge of managed care products and strategies • Ability to work within a changing business environment and balance patient advocacy with business needs • Experience managing multiple projects in a fast-paced matrix environment • Ability to educate colleagues and staff members • Experience with change management • Teamwork, negotiation, conflict management, decision-making, and problem-solving skills • Ability to assess complex issues, determine and implement solutions, and resolve problems • Ability to create and maintain cooperative relations with diverse internal and external stakeholders • Sensitivity to culturally diverse situations, participants, and customers/members • Service marketing, sales, and business acumen experience (a plus) • Home internet connection through cable broadband or fiber optic service with at least 10 Mbps download and 5 Mbps upload if working from home

🏖️ Benefits

• Annual bonus eligibility • Long term incentive plan eligibility • Medical benefits • Vision benefits • Dental benefits • Well-being and behavioral health programs • 401(k) • Company-paid life insurance • Tuition reimbursement • Minimum of 18 days of paid time off per year • Paid holidays • Leaves of absence • Remote work option (occasionally or permanently, subject to internet requirements)