Medical Senior Director

Cigna

(Chicago, Illinois)

Full Time

Job Posting Details

About Cigna

At Cigna, we're more than a health insurance company. We're a global health service company.

Responsibilities

- Responsible for utilization review decisions for all product lines in the local market.
- Conducts utilization review rounds activity for inpatient admissions and other disease management programs.
- Participates in Interdisciplinary Care Team meetings, Credentialing Meetings, and Provider Advisory Committee meetings as needed.
- Directs the medical policy for a single-market health plan. 
- Establishes and implements policies and standards, evaluates new treatments, and evaluates available data sources to ensure the quality of the medical care provided to members for single-market health plan. 
- May assist in outside presentations or provider recruitment and retention. 
- Responsible for chairing appropriate health services committees, providing leadership for pharmacy and health services utilization management projects, and assisting in the development and maintenance of medical management projects. 
- Provides support and guidance for appeals, medication prior-authorization requests, and benefit designs and levels. 
- Assists in working with other divisions for managing Medicare/Medicaid, as applicable, requirements. 
- Develops and maintains partnerships across departments within the division. 
- Responsible for successfully managing a high member to medical director ratio.

Responsible for utilization review decisions for all product lines in the local market.
Conducts utilization review rounds activity for inpatient admissions and other disease management programs.
Participates in Interdisciplinary Care Team meetings, Credentialing Meetings, and Provider Advisory Committee meetings as needed.
Directs the medical policy for a single-market health plan.
Establishes and implements policies and standards, evaluates new treatments, and evaluates available data sources to ensure the quality of the medical care provided to members for single-market health plan.
May assist in outside presentations or provider recruitment and retention.
Responsible for chairing appropriate health services committees, providing leadership for pharmacy and health services utilization management projects, and assisting in the development and maintenance of medical management projects.
Provides support and guidance for appeals, medication prior-authorization requests, and benefit designs and levels.
Assists in working with other divisions for managing Medicare/Medicaid, as applicable, requirements.
Develops and maintains partnerships across departments within the division.
Responsible for successfully managing a high member to medical director ratio.

Ideal Candidate

Degree in medicine from an accredited school and is licensed to practice medicine (Doctor of Medicine or Doctor of Osteopathic Medicine.)
Medical license must be active and unrestricted.
Board Certification in AMBS specialty.
At least 5 years of hands-on patient management in licensed discipline.
Ability to be hands on, adaptable, focused, flexible, data driven, results-oriented, and a high performer.
Good communication skills and project management skills.
Able to organize, prepare, and deliver presentations to groups or in one-on-one settings.
At least two years of clinical experience in a managed care organization.
Proven analytical skills.