Position scope: Primarily regional with national level case work for Cigna Healthcare (CHC) -- Cigna. Summary description of position: A Medical Principal performs medical review and case management activities. The physician provides clinical insight to the organization through peer review, benefit review, consultation, and service to internal and external customers. He/she will serve as a clinical educator and consultant to utilization management, case management, network, contracting, pharmacy, and service operations (claims). This is an entry to mid-level position for a physician interested in a career in health care administration. Major responsibilities and required results: - Performs benefit-driven medical necessity reviews for coverage, case management, and claims resolution, using benefit plan information, applicable federal and state regulations, clinical guidelines, and best practice principles. - Works to achieve quality outcomes for customers/members with a focus on service and cost - Improves clinical outcomes through daily interactions with health care professionals using active listening, education, and excellent communication and negotiation skills. - Balances customer/member needs with business needs while serving as a customer/member advocate at all times. - Participates in all levels of the Appeal process as appropriate and allowed by applicable regulatory agencies and accreditation organizations - Participates in coverage guideline development, development and maintenance of medical management projects, initiatives and committees. - Participates in quality processes such as audits, inter-rater reliability clinical reviews, and quality projects - Serves as a mentor or coach to other Medical Directors and other colleagues in quality and performance improvement processes. - Improves health care professional relations through direct communication, knowledge of appropriate evidence-based clinical information and the fostering of positive collegial relationships. - Demonstrates knowledge as a peer reviewer by applying current evidence-based guidelines, including novel treatments, to support high-quality clinical decision-making across medical and behavioral health conditions, diseases, treatments, and procedures. Medical directors are required to maintain and update their knowledge base through monthly focused updates of Cigna's comprehensive evidence-based coverage policies, as well as through mandatory inter-rater reliability testing, continuing medical education, and maintenance of board certification. - Addresses customer service issues with mentoring and support from leadership staff. - Investigates and responds to client and/or regulatory questions to assist in resolving issues or clarifying questions with mentoring and support from leadership staff. - Achieves internal customer satisfaction and regulatory/accreditation agency compliance goals by assuring both timely turn-around of coverage reviews and quality outcomes based on those review decisions. - Provides clinical insight and management support to other functional areas and matrix partners as needed or directed. Minimum Requirements: - Current unrestricted medical license in a US state or territory. - Current board certification (lifetime certification or certification maintained by MOC or other applicable program) in an ABMS or AOA recognized specialty - Exhibits ethical and professional behavior. - Minimum of 5 years of clinical practice experience and/or direct patient care beyond residency - Computer Competency: Word processing, Spreadsheet, Email, PowerPoint and Personal Information Management programs are used extensively and competency in all must be possessed or rapidly acquired. - Must not be excluded from participation in any federal health care program** - Must not be included in CMS’ Preclusion List** Preferred Skill Sets: - Experience in medical management, utilization review and case management in a managed care setting. - Knowledge of managed care products and strategies. - Ability to work within changing business environment and balance patient advocacy with business needs. - Experience with managing multiple projects in a fast-paced matrix environment. - Demonstrated ability to educate colleagues and staff members. - Successful experience and comfort with change management. - Demonstration of strong and effective abilities in teamwork, negotiation, conflict management, decision-making, and problem-solving skills. - Successful ability to assess complex issues, to determine and implement solutions, and resolve problems. - Success in creating and maintaining cooperative, successful relations with diverse internal and external stakeholders. - Demonstrated sensitivity to culturally diverse situations, participants, and customers/members. - Service marketing, sales, and business acumen experience a plus. - Fluency in Spanish (Cigna Medicare) or other languages 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 212,600 - 354,300 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 and long term incentive 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. For more details on our employee benefits programs, click here. About The Cigna Group Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives. 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 need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

We are seeking both part-time and full-time Psychiatric Nurse Practitioners to perform tele-psychiatric visits for clients based in Washington. If you enjoy working on a team with bright, ambitious advanced practice nurses and are seeking the flexibility and autonomy of private practice, this is an excellent opportunity for you. We offer a competitive 1099 compensation model and a supportive work environment that offers mentorship and training. You can build your own schedule within our operating hours, which are 8 a.m. to 8 p.m. seven days a week. We require a minimum commitment of 16 hours per week Benefits to Being a Lavender NP - Flexible self-scheduling - Paid physician collaborators - No patient minimums - ANCC-accredited continuing education - Fellowship program for NPs as part of onboarding - 3-month new grad mentorship program - UpToDate subscription - Paid EHR and e-Prescribe - Leadership development program - Teaching honorariums What Makes Lavender Special - A caring, spirited, and experienced team. We are nurse-founded and led - Be part of a company that is truly making a difference in the world - Work remotely with the full support of an expert team - An international work environment that embraces diversity and inclusion - Be part of a growing startup where you have the opportunity to help shape the company - Company-sponsored In-person meetups (so far we’ve gathered in New York and Mexico!) - Fun and engaging company culture with regular virtual team events - Competitive compensation - Annual giving program - donation by Lavender to your chosen charity - Book clubs and other community events The Responsibilities: Conduct initial evaluations and collaboratively develop treatment plans with clients for medication, therapy or a combination of both. Proactively follow up with clients at minimum on a monthly basis to assess the efficacy of recommended interventions and ongoing care until treatment goals are achieved. Our clientele strongly prefer combined medication and therapy appointments; you have to be comfortable providing various modalities of talk therapy. The Candidate: - Master of Science in Nursing (MSN) - Active Washington Psychiatric Nurse Practitioner License - ANCC Board Certification - 2+ years of experience working in adult mental health - Strong assessment skills - Excellent communication and documentation abilities - Ambitious, client-centric work ethic - Must have own computer and a quiet, professional space to take tele-psychiatry appointments Job Types: Full-time, Part-time, Contract Weekly schedule: - Monday to Friday - Weekend availability Work setting: - Remote Experience: - Psychiatric Nursing: 2 years (Preferred) License/Certification: - Washington Nurse Practitioner License (Required) - ANCC Board Certification (Required) - DEA Certification (Required) For more about what it’s like to work at Lavender, see our careers page at https://www.joinlavender.com/careers. Bring your whole self to work Lavender believes that nurturing an environment where diversity and inclusion can thrive is critical to our success. We are proud to be an equal opportunity employer and do not discriminate on the basis of any status protected by law, including race, color, religion, sex, orientation, gender identity or expression, national origin, age, disability, or genetic information. If you need accommodation during the recruitment process, please reach out to people@joinlavender.com.

About us LifeMD is a leading digital healthcare company committed to expanding access to virtual care, pharmacy services, and diagnostics by making them more affordable and convenient for all. Focused on both treatment and prevention, our unique care model is designed to optimize the patient experience and improve outcomes across more than 200 health concerns.  To support our expanding patient base, LifeMD leverages a vertically-integrated, proprietary digital care platform, a 50-state affiliated medical group, a 22,500-square-foot affiliated pharmacy, and a U.S.-based patient care center. Our company — with offices in New York City; Greenville, SC; and Huntington Beach, CA — is powered by a dynamic team of passionate professionals. From clinicians and technologists to creatives and analysts, we're united by a shared mission to revolutionize healthcare. Employees enjoy a collaborative and inclusive work environment, hybrid work culture, and numerous opportunities for growth. Want your work to matter? Join us in building a future of accessible, innovative, and compassionate care. About the role We are seeking a Physician who resides in the state of Mississippi, is able and willing to serve as a supervising Physician, is licensed in multiple states and is interested in providing patient care through our state-of-the-art telehealth platform. As a highly valued member of our dynamic team, you will collaborate with experienced Physicians, Nurse Practitioners, and a supportive staff. With the combined efforts of our team, we are determined to provide unparalleled care to our invaluable patients at LifeMD. Responsibilities - Deliver comprehensive clinical care through both text-based and video-based consultations, ensuring the wellbeing of the patients - Empower patients with knowledge by educating them on suitable treatments and personalized care plans for their specific health needs - Oversee patient follow-ups for ongoing care programs, ensuring continuity and effectiveness of treatment - Prescribe medication and provide timely refills as needed, ensuring patients have access to appropriate medications - Embrace remote work by conducting full-time telemedicine consultations. Enjoy the flexibility of 4-10 hour shifts while serving patients through our virtual primary care and weight loss offerings

We are hiring a Home Health Case Manager at BCBST! In this role, you will support TennCare (Medicaid) members with complex medical, functional and social needs. You will coordinate home and community-based care, conduct required home visits, and support members transitioning to adult benefits. You’ll collaborate closely with providers and internal care teams using digital tools to identify care gaps, reduce hospitalization risk, and improve outcomes. To be successful in this role, in addition to the core job requirements, you'll bring strong clinical judgement, experience using digital tools to communication, and availability for home visits. You will be a strong candidate for this role if you have the following: home health or hospice nursing experience, pediatric experience, knowledge of MTLSS programs, and familiarity with community-based services. Note: - This is a remote, Monday–Friday (8:00 a.m.–5:00 p.m.) role with flexibility to support member needs, however this role requires traveling to members' homes monthly in the Memphis area. - Candidates must live within 50 miles of Memphis. - Sponsorship is not available for this role. Job Responsibilities - Supporting utilization management functions for more complex and non-routine cases as needed. - Serving as a liaison between members, providers and internal/external customers in coordination of health care delivery and benefits programs. - Overseeing highly complex cases identified through various mechanisms to ensure effective implementation of interventions, and to ensure efficient utilization of benefits - Performing the essential activities of case management: assessment: planning, implementation, coordinating, monitoring, outcomes and evaluation. - Digital positions must have the ability to effectively communicate via digital channels and offer technical support. - Effective 7/22/13: This Position requires an 18 month commitment before posting for other internal positions. - Various immunizations and/or associated medical tests may be required for this position. - This job requires digital literacy assessment. Job Qualifications License - Registered Nurse (RN) with active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law. Experience - 3 years - Clinical experience required - 5 years - Experience in the health care industry - For Select Community & Katie Beckett: 2 years experience in IDD for Select Community is required Skills\Certifications - Excellent oral and written communication skills - PC Skills required (Basic Microsoft Office and E-Mail) Employees who are required to operate either a BCBST-owned vehicle or a personal or rental vehicle for company business on a routine basis* will be automatically enrolled into the BCBST Driver Safety Program. The employee will also be required to adhere to the guidelines set forth through the program. This includes, maintaining a valid driver’s license, auto insurance compliance with minimum liability requirements; as defined in the “Use of Non BCBST-Owned Vehicle” Policy (for employees driving personal or rental vehicles only); and maintaining an acceptable motor vehicle record (MVR). *The definition for "routine basis" is defined as daily, weekly or at regularly schedule times. Number of Openings Available 1 Worker Type: Employee Company: VSHP Volunteer State Health Plan, Inc Applying for this job indicates your acknowledgement and understanding of the following statements: BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law. Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page: BCBST's EEO Policies/Notices BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.