Medical Director
Location
United States
Posted
3 days ago
Salary
$212.6K - $354.3K / year
Seniority
Lead
No structured requirement data.
Job Description
Medical Director
The Cigna Group
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. Benefits - Annual salary of 212,600 - 354,300 USD / yearly, depending on relevant factors, including experience and geographic location. - Eligibility to participate in an annual bonus and long term incentive plan. - Comprehensive range of benefits, including medical, vision, dental, and well-being and behavioral health programs. - 401(k), company paid life insurance, tuition reimbursement. - A minimum of 18 days of paid time off per year, paid holidays, and leaves of absence.
Related Guides
Related Categories
Related Job Pages
More Medical Director Jobs
Role Description Sana Lake is seeking an as-needed (PRN) Medical Director who is passionate about supporting individuals and families in recovery! - The Medical Director is responsible for implementing strategies and developing processes that enhance member care and improve the program overall. - Responsible for the development and evaluation of standards of medical care. - Provides medical direction to clinical staff. - Advises the department in matters of medical policy. - This position is needed as a backup for our current Medical Director to cover illness or vacation. - A monthly stipend would be paid to retain services during the months services are not needed. Qualifications - Have graduated from an accredited college or university with a medical degree. - Have experience working with patients with behavioral health disorders and/or substance use disorders. - Are licensed to practice medicine in Missouri, and maintain current licensure per state requirements. - Are Board-certified in Psychiatry and/or Addiction Medicine. Requirements - Completion of pre-employment screening. - Verification of education and licensure, when applicable. - Satisfactory employment and/or reference checks. Benefits - Comprehensive medical, dental, vision, life insurance, and disability plan options. - Competitive 401(k) Retirement Savings Plan - up to 5% match! - Company paid basic life insurance. - Paid Time Off and Paid Holidays. - Flexible Spending Accounts. - Employee Assistance Program (EAP). - License/Certification Reimbursement. - Professional development funds. - Professional licensure supervision options. - Staff recognition program. - Sana Spirit Days. - Substance Use Disorder Treatment and Recovery Loan Repayment Site through STAR-LRP Program.
Business Development Director – Healthcare
CatenaEmpowering Talent. Elevating Companies. Uniting Success.
• Expand Pearl's presence across the healthcare technology and care delivery ecosystem. • Convert long-standing professional relationships into strategic client partnerships. • Build a repeatable pipeline of high-quality healthcare clients. • Shape Pearl's healthcare go-to-market strategy and market positioning. • Help establish Pearl as the leading talent partner for healthcare innovators. **Core Responsibilities** Business Development & Client Acquisition – 50% • Develop and close new business opportunities within the healthcare sector. • Leverage your professional network to generate warm introductions and strategic partnerships. • Own the full sales cycle from prospecting through contract execution. • Build long-term relationships with founders, executives, and operational leaders. Relationship Management & Account Growth – 25% • Serve as a trusted advisor to healthcare clients. • Identify opportunities to expand partnerships across existing accounts. • Collaborate with internal teams to ensure exceptional client experience. • Represent Pearl at industry conferences, networking events, and executive meetings. Vertical Strategy & Market Development – 15% • Identify emerging healthcare segments and growth opportunities. • Provide market intelligence to leadership on industry trends and customer needs. • Refine messaging and positioning for different healthcare audiences. • Help define Pearl's long-term healthcare growth strategy. Cross-Functional Collaboration – 10% • Partner with Recruiting to align client needs with talent strategies. • Work closely with Marketing on campaigns targeting healthcare organizations. • Collaborate with leadership to improve sales processes and client acquisition strategies.
Director, Clinical Trials Lead – Rare Disease, CKD
NateraFounded in 2004 and led by CEO Steve Chapman, Natera is a company in the biotechnology market that offers genetic testing and diagnostics on a global scale. Ope
• Champion our site engagement strategy to maximize clinical trial participation and serve as the executive escalation point for critical partnerships. • Lead a high-performing, cross-functional team (BD, Data Science, Product, Marketing) to translate partner needs into scalable, data-driven program opportunities. • Act as the principal medical point of contact for Pharma Partners, applying clinical and operational expertise to lead contract negotiation and cultivate long-term, high-impact relationships with key stakeholders. • Lead provider outreach and patient engagement efforts, leveraging deep clinical interpretation to optimize patient identification and trial enrollment. • Proactively identify opportunities for process optimization and contribute to organizational growth through the development and implementation of operational strategy and best practices.
Part Time Medical Director
Local InfusionWe are setting a new standard for infusion therapy—because patients deserve better.
• Provide required physician supervision for nurse practitioners in accordance with state regulations in Texas • Conduct quarterly (at minimum) virtual meetings with supervised nurse practitioners to: • Review clinical cases • Provide guidance and mentorship • Ensure adherence to clinical protocols and standards of care • Perform periodic chart reviews and quality assurance checks • Be available on an as-needed basis for clinical consultation • Collaborate with clinical leadership to support: • Ongoing quality improvement initiatives • Protocol development and updates • Compliance with regulatory and payer requirements • Maintain appropriate documentation of supervisory activities as required by the state
