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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 Plastic Surgery 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 patient health and vitality.
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 Plastic Surgery.
- 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.
- Ability to meet physical demands of the role including typing, speaking, and listening.
Nice-to-haves
- Eligible to acquire additional state licensure as required.
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
- Minimum of 18 days of paid time off per year and paid holidays
