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Medical Director

Position scope:

Primarily regional with national level case work for Cigna Healthcare (CHC) -- Cigna

Summary description of position:  A Medical Principal performs medical review and case management activities.  The physician provides clinical insight to the organization through peer review, benefit review, consultation, and service to internal and external customers.  He/she will serve as a clinical educator and consultant to utilization management, case management, network, contracting, pharmacy, and service operations (claims).  This is an entry to mid-level position for a physician interested in a career in health care administration. 

Major responsibilities and required results:

  • Performs benefit-driven medical necessity reviews for coverage, case management, and claims resolution, using benefit plan information, applicable federal and state regulations, clinical guidelines, and best practice principles.
  • Works to achieve quality outcomes for customers/members with a focus on service and cost
  • Improves clinical outcomes through daily interactions with health care professionals using active listening, education, and excellent communication and negotiation skills.
  • Balances customer/member needs with business needs while serving as a customer/member advocate at all times.
  • Participates in all levels of the Appeal process as appropriate and allowed by applicable regulatory agencies and accreditation organizations
  • Participates in coverage guideline development, development and maintenance of medical management projects, initiatives and committees.
  • Participates in quality processes such as audits, inter-rater reliability clinical reviews, and quality projects
  • Serves as a mentor or coach to other Medical Directors and other colleagues in quality and performance improvement processes.
  • Improves health care professional relations through direct communication, knowledge of appropriate evidence-based clinical information and the fostering of positive collegial relationships.
  • Demonstrates knowledge as a peer reviewer by applying current evidence-based guidelines, including novel treatments, to support high-quality clinical decision-making across medical and behavioral health conditions, diseases, treatments, and procedures. Medical directors are required to maintain and update their knowledge base through monthly focused updates of Cigna's comprehensive evidence-based coverage policies, as well as through mandatory inter-rater reliability testing, continuing medical education, and maintenance of board certification.
  • Addresses customer service issues with mentoring and support from leadership staff.
  • Investigates and responds to client and/or regulatory questions to assist in resolving issues or clarifying questions with mentoring and support from leadership staff.
  • Achieves internal customer satisfaction and regulatory/accreditation agency compliance goals by assuring both timely turn-around of coverage reviews and quality outcomes based on those review decisions.
  • Provides clinical insight and management support to other functional areas and matrix partners as needed or directed.

Minimum Requirements:

  • 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 are used extensively and competency in all must be possessed or rapidly acquired. 
  • Must not be excluded from participation in any federal health care program**
  • Must not be included in CMS’ Preclusion List**

Preferred Skill Sets:

  • 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 skills.
  • 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


If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an annual salary of 206,300 - 343,900 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus and long term incentive plan.

We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group.

About The Cigna Group

Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.

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.

If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

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Average salary estimate

$275100 / YEARLY (est.)
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$206300K
$343900K

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What You Should Know About Medical Director, The Cigna Group

Cigna Healthcare is looking for an experienced Medical Director to join their amazing team working from home in the United States. This role primarily focuses on regional case work with national implications, allowing you to leverage your clinical expertise in exciting ways. As a Medical Director, you'll be performing medical reviews and engaging in case management while providing valuable clinical insights both to internal teams and clients. This role is perfect for physicians who are ready to transition into health care administration. You'll be conducting benefit-driven medical necessity reviews, ensuring not just adherence to clinical guidelines but also aiming for remarkable quality outcomes for Cigna's customers. The position involves active communication and collaboration with healthcare professionals, advocating for members while balancing their needs with business objectives. This is not just a remote job; it’s about being at the forefront of improving health care. You will have the opportunity to mentor and coach peers, contribute to the development of coverage guidelines, and lead quality improvement initiatives. Moreover, your ability to stay updated with the latest evidence-based guidelines will be essential. If you have at least five years of clinical practice experience, a current medical license, and a passion for making a difference, this role could be your next great adventure. Plus, Cigna offers competitive salaries and a robust benefits package designed to support your well-being and growth.

Frequently Asked Questions (FAQs) for Medical Director Role at The Cigna Group
What are the main responsibilities of a Medical Director at Cigna Healthcare?

As a Medical Director at Cigna Healthcare, your key responsibilities will include performing medical necessity reviews, engaging in case management, and providing clinical insights through peer reviews and consultations. You’ll work towards achieving quality outcomes for customers and serve as a mentor for others in the organization.

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What qualifications are necessary for the Medical Director position at Cigna Healthcare?

To qualify for the Medical Director position at Cigna Healthcare, candidates must hold a current unrestricted medical license in a US state, have board certification in an ABMS or AOA recognized specialty, and possess a minimum of five years of clinical practice experience beyond residency.

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How does Cigna Healthcare support the ongoing development of its Medical Directors?

Cigna Healthcare actively supports the ongoing development of its Medical Directors by providing opportunities for continuing medical education, mandatory inter-rater reliability testing, and updates on evidence-based coverage policies, ensuring that you remain at the forefront of clinical knowledge.

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What skills are preferred for a Medical Director role at Cigna Healthcare?

Preferred skills for a Medical Director role at Cigna Healthcare include experience in medical management and utilization review, strong communication and negotiation skills, and the ability to balance patient advocacy with business needs. Fluency in Spanish or additional languages is also a plus.

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What can I expect from the benefits package at Cigna Healthcare for a Medical Director?

Cigna Healthcare offers an extensive benefits package for its Medical Directors, starting from your first day of employment. This includes medical, vision, dental, wellness programs, a 401(k) plan with company matching, and a generous paid time off policy.

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Common Interview Questions for Medical Director
What experience do you have in performing medical necessity reviews?

When answering this question, highlight specific experiences and any outcomes that demonstrate your skills in conducting thorough and fair medical necessity reviews, especially in managed care settings.

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How do you handle conflicts with healthcare professionals?

Discuss your conflict resolution approach by sharing an example where effective communication and collaboration helped to resolve a dispute, thereby reinforcing professional relationships.

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Can you describe your process for mentoring other medical staff?

Explain your mentoring philosophy and share specific strategies that have worked for you in fostering growth and improvement in other medical staff, leading to enhanced team performance.

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What do you think are the biggest challenges facing the healthcare industry today?

Provide an insightful analysis of current healthcare challenges e.g., regulatory changes or patient care quality, and illustrate how you've addressed or contributed to solutions in your past roles.

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How do you prioritize customer and business needs?

Share examples showcasing your ability to balance patient advocacy with the business needs of an organization, detailing how you’ve successfully managed both aspects in previous roles.

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What strategies do you use to ensure compliance with healthcare regulations?

Discuss your systematic approach to staying up to date on regulations and implementing compliance practices, reinforcing the importance of maintaining high standards in healthcare delivery.

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Describe a time when you improved clinical outcomes.

Use the STAR method to outline a specific instance where your actions as a Medical Director led to improved clinical outcomes, focusing on what strategies you employed.

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How do you stay updated on the latest medical guidelines?

Mention your commitment to professional development, detailing specific resources, courses, or networks that you engage with to keep your medical knowledge current.

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What is your experience with technology used in medical management?

Be sure to mention your proficiency with various tech platforms and tools, providing examples of how you’ve integrated technology into medical management practices effectively.

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Why do you want to work at Cigna Healthcare?

Your answer should reflect a genuine interest in Cigna’s mission to improve health and well-being, and perhaps mention specific aspects of the company culture, values, or initiatives that resonate with you.

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DATE POSTED
April 17, 2025

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