The Cigna Group is seeking a Medical Director - Medical Oncologist for a role focused on medical review and case management. As a Medical Principal, you will provide clinical insight through peer review, consultation, and serve as a clinical educator to internal teams. This is an entry to mid-level position for a physician interested in healthcare administration within a managed care setting.

What You'll Do

Perform benefit-driven medical necessity reviews for coverage, case management, and claims resolution.
Work to achieve quality outcomes for customers/members with a focus on service and cost.
Improve clinical outcomes through daily interactions with health care professionals using active listening, education, and negotiation.
Balance customer/member needs with business needs while serving as a customer/member advocate.
Participate in all levels of the Appeal process as appropriate.
Participate in coverage guideline development and maintenance of medical management projects and committees.
Participate in quality processes such as audits, inter-rater reliability clinical reviews, and quality projects.
Serve as a mentor or coach to other Medical Directors and colleagues in quality and performance improvement processes.
Improve health care professional relations through direct communication and fostering positive collegial relationships.
Demonstrate knowledge as a peer reviewer by applying current evidence-based guidelines, including novel treatments.
Address customer service issues with mentoring and support from leadership.
Investigate and respond to client and/or regulatory questions with mentoring and support from leadership.
Achieve internal customer satisfaction and regulatory compliance goals by assuring timely reviews and quality outcomes.
Provide clinical insight and management support to other functional areas and matrix partners as needed.

What We're Looking For

Current unrestricted medical license in a US state or territory.
Current board certification (lifetime certification or certification maintained by MOC or other applicable program) in an ABMS or AOA recognized specialty.
Exhibits ethical and professional behavior.
Minimum of 5 years of clinical practice experience and/or direct patient care beyond residency.
Computer Competency: Word processing, Spreadsheet, Email, PowerPoint and Personal Information Management programs.
Must not be excluded from participation in any federal health care program.
Must not be included in CMS’ Preclusion List.

Nice to Have

Experience in medical management, utilization review and case management in a managed care setting.
Knowledge of managed care products and strategies.
Ability to work within changing business environment and balance patient advocacy with business needs.
Experience with managing multiple projects in a fast-paced matrix environment.
Demonstrated ability to educate colleagues and staff members.
Successful experience and comfort with change management.
Demonstration of strong and effective abilities in teamwork, negotiation, conflict management, decision-making, and problem-solving.
Successful ability to assess complex issues, to determine and implement solutions, and resolve problems.
Success in creating and maintaining cooperative, successful relations with diverse internal and external stakeholders.
Demonstrated sensitivity to culturally diverse situations, participants, and customers/members.
Service marketing, sales, and business acumen experience a plus.
Fluency in Spanish (Cigna Medicare) or other languages.

Benefits & Compensation

Compensation: $206,300 - $343,900 USD per year.
Comprehensive health-related benefits including medical, vision, dental, and well-being and behavioral health programs starting day one.
401(k) with company match.
Company paid life insurance.
Tuition reimbursement.
Minimum of 18 days of paid time off per year and paid holidays.

Work Mode

This is a hybrid position.

The Cigna Group is dedicated to improving the health and vitality of those we serve and committed to enhancing the lives of our clients, customers and patients. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.