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Cigna - Bloomfield, NJ

posted about 1 month ago

Full-time - Senior
Hybrid - Bloomfield, NJ
Insurance Carriers and Related Activities

About the position

As a Cardiology Medical Director at eviCore, part of Evernorth Health Services, you will leverage your clinical expertise to conduct evidence-based medical reviews for patient care. This role involves collaborating with healthcare providers, staying updated on healthcare regulations, and reviewing a variety of medical cases. You will have the opportunity to enhance your skills while making a significant impact on patient health and vitality.

Responsibilities

  • Complete time-sensitive, specialized evidence-based medical case reviews for medical necessity using eviCore's case management software.
  • Conduct physician consultation (peer-to-peer) calls with referring providers to discuss evidence-based medical necessity and appropriateness of requested services or treatments.
  • Leverage clinical expertise to recommend alternative services or treatments as necessary.
  • Collaborate with over 500 eviCore physician colleagues to ensure patients receive proper care through evidence-based decision making.

Requirements

  • M.D. or D.O. with a current, active U.S. state medical license and board certified in Cardiology.
  • 5 years of relevant clinical experience post-residency/fellowship.
  • Knowledge of applicable state and federal laws.
  • Familiarity with Utilization Review Accreditation Commission and National Committee for Quality Assurance standards is a plus.
  • Strong computer skills and ability to work autonomously with automated processes and systems.

Nice-to-haves

  • Eligible to acquire additional state licensure as required.
  • Prefer one of the following state medical licenses: DC, MD, or VA.

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
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