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Cigna Group

Sells health coverage and pharmacy benefits

Medical Director - Maternal-Fetal Medicine, Ob/Gyn

Physicians & SurgeonsConfirmed live in the last 24 hours
Full-timeRemote in USARemote

About the Job

Requirements

  • Hold an M.D. or D.O. degree with a current, active United States medical license and board certification through the American Board of Medical Specialties or American Osteopathic Association in Maternal-Fetal Medicine.
  • Be eligible to acquire additional state licensure as required.
  • Have at least 3 years of relevant clinical experience after residency or fellowship.
  • Commit to a set weekly Monday-through-Friday work schedule.
  • Work autonomously with automated processes, computer applications, and systems.
  • Meet the physical demands of typing, speaking, and listening for 100% of the work time.
  • Use a company-provided encrypted workstation connected by hard wire to a modem or router; wireless connection is not permitted.
  • Use cable broadband or fiber-optic internet service with at least 10 Mbps download and 5 Mbps upload speeds when working from home.

Responsibilities

  • Complete time-sensitive, specialized, evidence-based medical case reviews for medical necessity using EviCore’s case management software.
  • Conduct physician consultation, or peer-to-peer, calls with referring providers regarding evidence-based medical necessity and appropriateness of requested services or treatments.
  • Use clinical expertise to recommend alternative services or treatments when necessary.
  • Collaborate with physician colleagues to help ensure patients receive appropriate care through evidence-based decision-making.
  • Stay current on healthcare regulations and industry developments while reviewing cases.

Desired Qualifications

  • Knowledge of applicable state and federal laws, Utilization Review Accreditation Commission standards, and National Committee for Quality Assurance standards.

About the Company

Cigna Group

Sells health coverage and pharmacy benefits

The Cigna Group sells health coverage and pharmacy services to employers, health plans and individuals, and most of its business runs through Evernorth, its health services arm. Evernorth owns Express Scripts, one of the largest pharmacy benefit managers in the U.S., which negotiates drug prices and processes prescriptions for plan sponsors, plus the specialty pharmacy Accredo. Its Cigna Healthcare unit sells medical, dental and behavioral coverage, mostly to employers that fund their own plans, and earns premiums and administrative fees, while Evernorth earns service fees and drug margins. The company was formed in 1982 through the merger of Connecticut General and INA and is based in Bloomfield, Connecticut.

Company size
10,001+
Company stage
Not listed
Total funding
Not listed
Headquarters
Bloomfield, CT
Founded
1982

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