Medical Director

🔥 47 minutes 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

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 • Use benefit plan information, federal and state regulations, clinical guidelines, and best-practice principles • Achieve quality outcomes for customers and members while focusing on service and cost • Improve clinical outcomes through interactions with health care professionals, including 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 appeal 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, to peer review across medical and behavioral health conditions • Maintain knowledge through monthly updates to Cigna coverage policies, 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 reviews and quality outcomes for regulatory and accreditation compliance • Provide clinical insight and management support to 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 • Minimum of 5 years of clinical practice experience and/or direct patient care beyond residency • Ethical and professional behavior • 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 • If working at home, internet connection through cable broadband or fiber optic service with at least 10 Mbps download/5 Mbps upload • Preferred: experience in medical management, utilization review, and case management in a managed care setting • Preferred: knowledge of managed care products and strategies • 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 skills • Preferred: ability to assess complex issues, determine and implement solutions, and resolve problems • Preferred: experience maintaining relations with diverse stakeholders • Preferred: sensitivity to culturally diverse situations • 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