Medical Senior Director


(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.
- 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.


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