Medical Director

Medical Director, Post-Acute Care

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.

Responsibilities include:

• 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

Minimum Education, Licensure and Professional Certification requirement:

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

Competencies:

• Decision Quality
• Persuades
• Interpersonal Savvy
• Manages Conflict
• Self-Development

FLSA (Exempt or Non-Exempt): Exempt

Bonus Type: (Indicate which option is applicable):

• Corporate Incentive Plan - CIP (Exempt Team Members)
• Corporate Success Share Plan - SHARE (Non-Exempt Team Members)
• Department Incentive Plan
• Quarterly
• Monthly

Status: Part Time.75 FTE and 3 days/week schedule (10 hour days)

Required Skills: Must be able to type 30 WPM, be proficient computer skills and knowledge of Microsoft Office applications

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 207,800 - 346,300 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

At The Cigna Group, you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.