Medical Director

🔥 1 minute ago

🇺🇸 United States – Remote

💵 $212.6k - $354.3k / 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

• 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 and members, with 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 advocating for customers and members • Participate in all appropriate levels of the appeals process • 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 Medical Directors and colleagues in quality and performance improvement • Improve health care professional relations through direct communication and evidence-based clinical information • Apply evidence-based guidelines, including novel treatments, across medical and behavioral health conditions, diseases, treatments, and procedures • Maintain and update clinical knowledge through monthly coverage-policy updates, inter-rater reliability testing, continuing medical education, and board-certification maintenance • Address customer service issues with leadership support • Investigate and respond to client and regulatory questions • Support 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 in an ABMS- or AOA-recognized specialty, maintained through lifetime certification, MOC, or another applicable program • Ethical and professional behavior • Minimum of 5 years of clinical practice experience and/or direct patient care beyond residency • Competency in word processing, spreadsheets, 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 balance patient advocacy with business needs preferred • Experience managing multiple projects in a fast-paced matrix environment preferred • Ability to educate colleagues and staff members preferred • Experience with change management preferred • Teamwork, negotiation, conflict management, decision-making, and problem-solving abilities preferred • Ability to assess complex issues, implement solutions, and resolve problems preferred • Ability to create and maintain cooperative relationships with diverse internal and external stakeholders preferred • Sensitivity to culturally diverse situations, participants, and customers/members preferred • Service marketing, sales, and business acumen experience is 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 requirement for home working, with at least 10Mbps download/5Mbps upload