Associate Medical Director – General Surgery at Cigna

Remote
Cigna

Associate Medical Director General Surgery Work from home eviCore

  • United States Work at Home

Thinking about joining eviCore as an Associate Medical Director?

Working at eviCore allows you to make a difference in people’s lives by improving the quality of their healthcare. As an Associate Medical Director, you will feel intellectually stimulated and challenged, and you will be empowered by the difference you are making on a more global level in healthcare.

Additional advantages of working at eviCore as an Associate Medical Director include:

Predictable work schedules: No nights, no weekends, no call

100% Remote full-time opportunity

  • Salaried position with benefits
  • The ability to impact healthcare on a larger scale
  • Supportive organization with collaborative culture: Hands-on training provided in our Melbourne, FL office (currently training is being conducted remotely)

Responsibilities:

  • Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in the United States.
  • Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.
  • Provides timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions.
  • Documents all actions related to clinical review sessions and attests to appeal review qualifications as required.
  • Maintains necessary credentials and immediately informs eviCore of any adverse actions relating to medical licenses and/or board certifications.
  • Participates in strategic planning for and evaluation of the Care Management process/unit.

Minimum Requirements:

  • The successful candidate will be an M.D. or D.O. with a current, active, U.S. state medical license and board-certified in General Surgery, recognized by the American Board of Medical Specialties (ABMS), or American Osteopathic Association (AOA)
  • Recent practice experience in direct patient care (within the past 18 months).
  • Must have a minimum of 5 years clinical experience, beyond residency/fellowship
  • Knowledge of applicable state and federal laws, URAC and NCQA standards a plus, and familiarity with automated processes and computer applications and systems is required
  • This position is not eligible to be performed in Colorado.

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