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.
- 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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