Medical Director

🔥 18 hours ago

🇺🇸 United States – Remote

💵 $230.6k - $384.4k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

👻 Ghost score 0%

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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

• Perform benefit-driven medical necessity reviews for coverage, case management, and claims resolution • Use benefit plan information, federal and state regulations, clinical guidelines, and best practice principles in reviews • Work to achieve quality outcomes for customers/members with a focus on service and cost • Improve clinical outcomes through daily interactions with health care professionals using listening, education, communication, and negotiation • Balance customer/member needs with business needs while serving as a customer/member advocate • Participate in all levels of the Appeal process as appropriate and allowed • Participate in coverage guideline development and medical management projects, initiatives, and committees • Participate in audits, inter-rater reliability clinical reviews, and quality projects • Mentor or coach other Medical Directors and colleagues in quality and performance improvement processes • Improve health care professional relations through direct communication and evidence-based clinical information • Apply current evidence-based guidelines, including novel treatments, in peer review and clinical decision-making across medical and behavioral health conditions • Maintain and update knowledge through monthly focused updates of Cigna’s evidence-based coverage policies, mandatory inter-rater reliability testing, continuing medical education, and board certification maintenance • Address customer service issues with leadership mentoring and support • Investigate and respond to client and regulatory questions • Ensure timely coverage review turnaround and quality outcomes to achieve customer satisfaction and regulatory/accreditation compliance • Provide clinical insight and management support to functional areas and matrix partners as needed

🎯 Requirements

• Current unrestricted medical license in a US state or territory • Current board certification (lifetime certification or certification maintained by MOC or other applicable program) in an ABMS or AOA recognized specialty • 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, PowerPoint and Personal Information Management programs • Must not be excluded from participation in any federal health care program • Must not be included in CMS’ Preclusion List • Experience in medical management, utilization review and case management in a managed care setting preferred • Knowledge of managed care products and strategies preferred • Ability to work within changing business environment and balance patient advocacy with business needs preferred • Experience with managing multiple projects in a fast-paced matrix environment preferred • Demonstrated ability to educate colleagues and staff members preferred • Successful experience and comfort with change management preferred • Teamwork, negotiation, conflict management, decision-making, and problem-solving skills preferred • Ability to assess complex issues, determine and implement solutions, and resolve problems preferred • Ability to create and maintain cooperative relations with diverse internal and external stakeholders preferred • Sensitivity to culturally diverse situations, participants, and customers/members preferred • Service marketing, sales, and business acumen experience a plus

🏖️ Benefits

• Annual bonus eligibility • Long term incentive plan eligibility • Medical insurance • Vision insurance • Dental insurance • 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 • Cable broadband or fiber optic internet service with at least 10Mbps download/5Mbps upload for home workers