Medical Principal – Gastroenterologist

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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

• A Medical Principal performs medical review and case management activities. • Provides clinical insight to the organization through peer review, benefit review, consultation, and service to internal and external customers. • Serves as a clinical educator and consultant to utilization management, case management, network, contracting, pharmacy, and service operations (claims). • Performs benefit-driven medical necessity reviews for coverage, case management, and claims resolution, using benefit plan information, applicable federal and state regulations, clinical guidelines, and best practice principles. • Works to achieve quality outcomes for customers/members with a focus on service and cost. • Improves clinical outcomes through daily interactions with health care professionals using active listening, education, and excellent communication and negotiation skills.

🎯 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 (Gastroenterology) • Minimum of 5 years of clinical practice experience and/or direct patient care beyond residency. • Computer Competency: Word processing, Spreadsheet, Email, PowerPoint and Personal Information Management programs are used extensively and competency in all must be possessed or rapidly acquired. • Must not be excluded from participation in any federal health care program. • Must not be included in CMS’ Preclusion List.

🏖️ Benefits

• medical, vision, dental, and well-being and behavioral health programs • 401(k) • company paid life insurance • tuition reimbursement • a minimum of 18 days of paid time off per year • paid holidays • leaves of absence