Medical Director – Pediatric Nephrology

🕒 June 3

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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

• As a Medical Director at EviCore, you’ll leverage your background in Pediatric Nephrology to deliver evidence-based medical reviews that support high-quality patient care. • Collaborate with healthcare providers and stay current on healthcare regulations and industry developments as you review a wide range of cases. • You’ll start training remotely in a structured environment with support from trainers, mentors, and leadership to set you up for success. • Complete time-sensitive, specialized evidence-based medical case reviews for medical necessity on EviCore’s case management software. • Conduct physician consultation (peer-to-peer) calls with referring providers to discuss evidence-based medical necessity and appropriateness of the requested service or treatment. • Leverage your clinical expertise to recommend alternative services or treatments as necessary. • Work collaboratively with over 500 EviCore physician colleagues to help ensure patients receive proper care via evidence-based decision making.

🎯 Requirements

• M.D. or D.O. with a current, active U.S. medical license and board certification (ABMS or AOA) in Pediatric Nephrology. • Eligible to acquire additional state licensure as required • 3 or more years of relevant clinical experience post residency/fellowship • Knowledge of applicable state and federal laws, Utilization Review Accreditation Commission and National Committee for Quality Assurance standards is a plus • Ability to commit to a set, weekly work schedule (Monday through Friday) • Strong computer skills: ability to work autonomously with automated processes, computer applications, and systems • Meet physical demands of the role including, but not limited to, typing, speaking, and listening 100% of time • In accordance with our HITECH Security Accreditation, company provided encrypted-workstation is required to be hard-wire connected to a modem or router. Wireless connection is not permitted. 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.

🏖️ Benefits

• Benefits start on day one • Predictable work schedules • 100% work from home • 8 Paid Holidays + 23 PTO Days • 401(K) with company match • Reimbursement for continuing medical education • Career growth opportunities across the enterprise • Networking with peers across multiple medical specialties