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Cigna - Bloomfield, NJ
posted about 2 months ago
About the position
As a Pediatric Otolaryngology Medical Director at eviCore, part of Evernorth Health Services, you will leverage your clinical expertise to conduct evidence-based medical reviews and collaborate with healthcare providers. This role emphasizes the importance of clinical judgment and communication skills while providing the opportunity to enhance your skills and improve patient care. You will work remotely, supported by a structured training environment, and engage in peer-to-peer consultations to ensure appropriate medical necessity and treatment recommendations.
Responsibilities
- Complete time-sensitive, specialized evidence-based medical case reviews for medical necessity using eviCore's case management software.
- Conduct physician consultation (peer-to-peer) calls with referring providers to discuss evidence-based medical necessity and appropriateness of requested services or treatments.
- Leverage clinical expertise to recommend alternative services or treatments as necessary.
- Collaborate with over 500 eviCore physician colleagues to ensure patients receive proper care through evidence-based decision making.
Requirements
- M.D. or D.O. with a current, active U.S. state medical license and board certified in Pediatric Otolaryngology recognized by the American Board of Medical Specialties or American Osteopathic Association.
- 5 years of relevant clinical experience post-residency/fellowship.
- Knowledge of applicable state and federal laws.
- Familiarity with Utilization Review Accreditation Commission and National Committee for Quality Assurance standards is a plus.
- Strong computer skills and ability to work autonomously with automated processes and systems.
Nice-to-haves
- Eligible to acquire additional state licensure as required.
- Prefer one of the following state medical licenses: DC, MD, or VA.
Benefits
- Benefits start on day one
- Predictable work schedules
- 100% work from home
- 8 Paid Holidays + 23 PTO Days
- 401(K) with company match
- Reimbursement for continuing medical education
- Career growth opportunities across the enterprise
- Networking with peers across multiple medical specialties
- Comprehensive health-related benefits including medical, vision, dental, and well-being programs
- Company paid life insurance
- Tuition reimbursement
