Medical Director

🔥 14 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

Founded 1982

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare • 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

• Lead a team of clinicians to deliver superior organizational results through utilization management functions and strategic clinical initiatives • Perform benefit-driven medical necessity reviews for coverage, case management, and claims resolution using benefit plan information, federal and state regulations, clinical guidelines, and best-practice principles • Work to achieve quality outcomes for customers with a focus on service and cost • Improve clinical outcomes through daily interactions with health care professionals using active listening, education, communication, and negotiation • Balance customer/member needs with business needs while serving as a customer advocate • Participate in all levels of the appeal process as appropriate • Participate in coverage guideline development, medical management project development and maintenance, and quality committees • Participate in quality reviews, inter-rater reliability clinical reviews, and quality projects • Mentor or coach Medical Directors and colleagues in quality and performance improvement processes • Improve health care professional relations through direct communication and evidence-based clinical information • Address customer service issues with mentoring and support from leadership • Investigate and respond to client and regulatory questions • Achieve customer satisfaction and regulatory/accreditation compliance through timely coverage reviews and quality outcomes • 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 as required • Create and implement medical management strategic plans • Support network operations and act as 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, spreadsheets, email, and Personal Information Management programs • Ability to research clinical issues on 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 but not required) • Experience in medical management, utilization review and case management in a managed care setting • Knowledge of managed care products and strategies • Ability to work within changing business environment and balance patient advocacy with business needs • Experience with managing multiple projects in a fast-paced matrix environment • Demonstrated ability to educate colleagues and staff members • Successful experience and comfort with change management • Strong teamwork, negotiation, conflict management, decision-making, and problem-solving abilities • 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 • Demonstrated sensitivity to culturally diverse situations, participants, and customers/members • Service marketing, sales, and business acumen experience (a plus) • For permanent or occasional work at home, cable broadband or fiber optic internet service with at least 10 Mbps download and 5 Mbps upload

🏖️ 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 • Tobacco-free policy