The Associate Medical Director (AMD) 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 supports the Product Clinical Management 2500 group and report to the Senior Medical Director, PAC or  Program Chief, PAC/DME/Sleep Services.

Responsibilities:

• Provide timely expert medical review of medical necessity requests for clinical services (including post-acute care and uncomplicated durable medical equipment (DME) requests) 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
• Conduct weekly Case Conferences with nursing and social worker teams; discussing every assigned member receiving care in a post-acute care facility, focusing on discharge planning, complex medical care management, quality of care, appropriate level of care, and appropriate length of stay
• Provide intermittent weekend call coverage of PAC and DME cases.
• 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

Qualifications:

• 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
• Full time – 40 hour week
• Required Skills: Must be able to type 30 WPM, be proficient computer skills and knowledge of Microsoft Office applications

This role is WAH/Flex, which allows most work to be performed at home. WAH/Flex employees must be fully vaccinated against COVID-19 if they choose to come onsite or if required to periodically come on site.

For this position, we anticipate offering an annual salary of $187,100 - $311,900, depending on relevant factors, including experience and geographic location.

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

Helping our customers achieve healthier, more secure lives is at the heart of what we do. While you take care of our customers, we’ll take care of you through a comprehensive benefits program that helps you be at your best. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and best in class well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and dozens of corporate discounts on essentials you use every day. For more details on our employee benefits programs, please visit the “Life at Cigna” tab on our careersite: www.cigna.com/careers

About Cigna

Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you’ll enjoy meaningful career experiences that enrich people’s lives. What difference will you make?

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.

If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.