Medical Director

🔥 12 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

• 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 practices • 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 active listening, education, communication, and negotiation • Balance customer/member needs with business needs while advocating for customers/members • Participate in all appropriate and permitted levels of the appeal process • Participate in coverage guideline development and the development and maintenance of 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 processes • Improve health care professional relations through direct communication and evidence-based clinical information • Apply current evidence-based guidelines, including novel treatments, as a peer reviewer across medical and behavioral health conditions, diseases, treatments, and procedures • Maintain and update knowledge through monthly focused updates of Cigna’s evidence-based coverage policies, mandatory inter-rater reliability testing, continuing medical education, and maintenance of board certification • 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 goals through timely coverage reviews and quality review decisions • Provide clinical insight and management support to other functional areas and matrix partners

🎯 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 • Competency in word processing, spreadsheet, email, PowerPoint, and Personal Information Management programs, or ability to rapidly acquire competency • Must not be excluded from participation in any federal health care program • Must not be included in CMS’ Preclusion List • Cable broadband or fiber optic internet service with at least 10Mbps download/5Mbps upload when working at home • Preferred: 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 environments and 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: change management experience • Preferred: teamwork, negotiation, conflict management, decision-making, and problem-solving abilities • Preferred: ability to assess complex issues, determine and implement solutions, and resolve problems • Preferred: ability to create and maintain cooperative relations with diverse stakeholders • Preferred: sensitivity to culturally diverse situations, participants, and customers/members • Service marketing, sales, and business acumen experience is a plus

🏖️ 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