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Cigna - Bloomfield, NJ
posted about 2 months ago
Full-time - Senior
Hybrid - Bloomfield, NJ
Insurance Carriers and Related Activities
About the position
As a Pediatric Pulmonology Medical Director at eviCore, part of Evernorth Health Services, you will leverage your clinical expertise to conduct evidence-based medical reviews for patient care. This role involves collaborating with healthcare providers, staying updated on healthcare regulations, and reviewing a variety of cases. You will have the opportunity to enhance your skills while making a significant impact on the health and vitality of patients.
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 Pulmonology.
- 5 years of relevant clinical experience post-residency/fellowship.
- Strong computer skills and ability to work autonomously with automated processes and systems.
- Knowledge of applicable state and federal laws, and standards from the Utilization Review Accreditation Commission and National Committee for Quality Assurance is a plus.
- Ability to commit to a set, weekly work schedule (Monday through Friday).
- Meet physical demands of the role including typing, speaking, and listening 100% of the time.
Nice-to-haves
- Eligible to acquire additional state licensure as required (preferably 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
