Medical Director

The Cigna Group

6d • $207,800 - $346,300 • Remote

About The Position

The Medical Director (MD) provides timely expert medical review of medical necessity requests for clinical services that do not meet utilization review criteria and renders a clinical opinion about the medical service under review while located in a state or territory of the United States. This role will entail working 10 hours every Monday and Friday and alternating weekends 10 hour daily (Saturday and Sunday shifts). This role will also provide coverage for other Medical Directors when on PTO as necessary.

Requirements

• M.D. or D.O. degree from accredited institution.
• Minimum of five (5) years of clinical practice experience after completion of all graduate medical education training, including residency and fellowship (when applicable)
• Active unrestricted license to practice medicine in a state or territory of the United States as a utilization review doctor of medicine or doctor of osteopathic medicine.
• Knowledge of applicable state and federal laws, URAC and NCQA standards, and utilization management
• Must be able to type 30 WPM
• Proficient computer skills and knowledge of Microsoft Office applications
• Internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

Nice To Haves

• Active board certification, primary care specialties (Family Medicine, Internal Medicine, Emergency Medicine) preferred.

Responsibilities

• Provide timely expert medical review of medical necessity requests for clinical services (including post-acute care)and render a clinical opinion about the medical service under review, including post-decision reviews.
• Provide timely and collegial peer-to-peer discussions with treating physicians to clarify clinical information and to explain review outcome decisions.
• Document all actions related to clinical review sessions and attest to review qualifications as required.
• Participate in rounds as necessary when providing coverage for other Medical Directors.
• Maintain necessary credentials and immediately inform eviCore of any adverse actions relating to medical licenses and/or board certifications.
• Support the review of eviCore clinical guidelines.
• Support and communicate eviCore policies and procedures to the provider community.
• Testify at ALJ Hearings when your cases are being appealed
• Assist with staff educational training and in-service programs and serve as a clinical resource for eviCore staff.
• Serve as a Subject Matter Expert when Medical Directors and/or Senior Medical Directors are unavailable.
• Participate in all required educational and quality improvement activities and maintain passing scores in all assessments.
• Assist in reviewing case determinations from clients responding to a provider or member complaint
• Maintain necessary credentials and immediately inform eviCore of any adverse actions relating to medical licenses and/or board certifications
• Other duties as assigned

Benefits

• medical
• vision
• dental
• 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

What This Job Offers

• Job Type: Part-time
• Career Level: Senior