• Provide clinical oversight and medical direction for vision related programs and services. • Ensure clinical policies, guidelines, and practices align with evidence based ophthalmology standards and applicable regulatory requirements. • Serve as the senior clinical authority for ophthalmology related questions, escalations, and complex case reviews. • Ensure compliance with GAAP, healthcare-specific regulations, and internal policies. • Perform and oversee utilization management reviews related to ophthalmology and vision services. • Conduct medical necessity determinations for prior authorization, concurrent, and retrospective reviews. • Review and adjudicate clinical appeals and denials, including peer to peer discussions with ordering and rendering providers. • Collaborate with operational and compliance teams to ensure utilization management activities meet contractual, regulatory, and accreditation standards. • Act as a client‑facing clinical leader and ophthalmology specialist for Health Network One’s vision service lines. • Participate in client meetings, presentations, and consultations to explain clinical programs, utilization management decisions, and outcomes. • Support client relationships, retention, and growth by providing credible, thoughtful clinical guidance. • Represent Health Network One with external stakeholders, including health plans, provider partners, and regulatory entities, as appropriate. • Partner with the CEO and executive leadership team to support strategic planning, clinical program design, and growth initiatives for vision services. • Provide clinical insight to inform organizational decision making, risk management, and performance improvement efforts. • Contribute to the development and refinement of clinical workflows, quality initiatives, and performance metrics aligned with organizational goals. • Ensure compliance with federal and state regulations, accreditation standards, and client contractual requirements. • Support quality management activities related to ophthalmology and vision services, including audits, reporting, and corrective action planning. • Promote a culture of clinical excellence, accountability, and patient centered decision making.

Role Description 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. - 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. - 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. Qualifications - 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. Requirements - 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 or other languages. Benefits - 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.

Role Description 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. - 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. - 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. Qualifications - 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. Requirements - 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 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. Benefits - 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. - 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. - Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Role Description The MSL role embodies our medical mission to be recognized as the trusted partner for internal stakeholders and the healthcare community, driving scientific exchange to enhance medical education, data generation, insight generation, and patients’ access to medicine. The Medical Science Liaison (MSL) is responsible for identifying disease and product related medical needs in a defined geography. - The Regional Oncology MSL role is field-based, and it is anticipated that the majority of their time will be spent in the field with external customers. - Serves as an educational resource for external Oncology stakeholders in the Community. - Primary responsibility is to communicate scientific and medical information supporting Multiple Myeloma and future Oncology pipeline assets. - Support the safe, effective, and appropriate use of BMS medicines. - Scientific dialogue focuses on: - scientific/clinical/safety information around Multiple Myeloma disease management and BMS products in a fair and balanced way - appropriate clinical value-based discussions. - Demonstrate strong medical and cross-functional or matrix collaboration. - Develop and maintain relationships with community-based thought leaders, appropriate community HCPs, and access stakeholders, within a given geography to answer specific clinical and/or scientific, unsolicited product and adverse event management related questions. - Use various channels for interactions (face to face 1:1 or group presentation; virtual). - Demonstrate proficiency in using available scientific resources and presentations. - Effectively present information to HCPs and be able to respond to questions, ensuring medical accuracy and compliance with local procedures, ethical and legal guidelines and directives. - Exceptional presentation skills. - Actively assess the medical and healthcare landscape by meeting with TLs/HCPs to understand their needs and expertise. - Continuously update knowledge in treatment strategies, products, unmet medical needs, clinical trials, and scientific activities. - Understand the competitive landscape and actively prepare to address the informational needs of customers. - Collect and provide meaningful medical insights back to the medical and commercial organizations to be actioned in support of strategy development. - Adapt to change in objectives and territory with continuing focus on Community HCPs and institutional or health system needs. - Demonstrate understanding of relevant HEOR and access resources as required. - Field execution of established Medical Plans. - Adopt institution/account planning approach and contribute to cross-functional institution/account plans. - Contribute to the development and delivery of scientifically meaningful medical programs/projects in line with the local Medical and Field Medical plan. - Support the initial and ongoing medical/scientific area and product specific training and provide key scientific updates to internal stakeholders (e.g. Commercial, Pharmacovigilance, Legal, HEOR, Market Access, Portfolio marketing). Qualifications - MD, PharmD, PhD, APP, PA, NP with experience in a specific Disease Area or with a broad medical background and relevant pharmaceutical experience. - Disease area knowledge and an understanding of scientific publications. - Knowledge of a scientific or clinical area, competitive landscape, and patient treatment trends. - Knowledge of clinical trial design and process. - Knowledge of the national healthcare and access environment. - Knowledge of HEOR core concepts. - Excellent English language skills, spoken and written. Requirements - A minimum of 2 years working in a pharmaceutical environment. - Prior MSL experience. - Ability to work independently and act as a team player. - Translating scientific or clinical data into an understandable and valuable form to help physicians best serve their patients. - Good communication and presentation skills to present scientific and/or clinical data to research or healthcare professionals. - Developing peer-to-peer relationships with TLs, scientists, and other healthcare professionals. - Ability to quickly and comprehensively learn about new subject areas and environments. - Demonstration of the BMS Values (innovation, urgency, accountability, Inclusion, Integrity, and Passion). - Ability to drive a company-provided car is an essential qualification of this position. - Possess a high level of ethics, integrity, and a responsible and safe driving history. - Act with an enterprise mindset. - Practice authentic leadership by cultivating honest relationships, seeking to understand blind spots, and staying true to own values and those of BMS, even in the face of challenge. - Possess a positive attitude and change agility during times of transition. - Demonstrate a growth mindset and is open to innovation and process improvements. - Contribute to talent development by providing timely feedback, understanding what will enable team success, and maintaining a strong network. - Actively engage in live meetings and teleconferences. - Completion of all administrative aspects of the job. Travel Requirement - Travel required. - Position is field-based; MSL will be required to live in the region which they manage. - The MSL will spend the majority of their time (> 60%) in the field with their external customers. - Further requirements based on territory assignment and team needs. Benefits - Health Coverage: - Medical, pharmacy, dental, and vision care. - Wellbeing Support: - Programs such as BMS Well-Being Account, BMS Living Life Better, and Employee Assistance Programs (EAP). - Financial Well-being and Protection: - 401(k) plan, short- and long-term disability, life insurance, accident insurance, supplemental health insurance, business travel protection, personal liability protection, identity theft benefit, legal support, and survivor support. - Work-life benefits include: - Paid Time Off: - US Exempt Employees: flexible time off (unlimited, with manager approval, 11 paid national holidays). - Phoenix, AZ, Puerto Rico, and Rayzebio Exempt, Non-Exempt, Hourly Employees: 160 hours annual paid vacation for new hires with manager approval, 11 national holidays, and 3 optional holidays. - Based on eligibility, additional time off for employees may include unlimited paid sick time, up to 2 paid volunteer days per year, summer hours flexibility, leaves of absence for medical, personal, parental, caregiver, bereavement, and military needs, and an annual Global Shutdown between Christmas and New Year's Day.