Senior Medical Director, Oncology Solutions- EviCore

Responsibilities

The Senior Medical Director, Oncology Solutions, is a critical intraday leader of EviCore’s Oncology management programs and services. Responsibilities include:

• Serve as a coach, mentor, and/or clinical supervisor for adult and pediatric oncology Medical Directors
• Assist in implementing and managing aspects of both the oncology imaging and the medical oncology programs as necessary
• Serve as a Subject Matter Expert and first point of contact for Medical Directors who are seeking assistance with problematic case reviews, or escalated cases that deserve immediate review and attention
• Respond to urgent, expedited, or escalated cases and P2Ps within areas of expertise
• Assist in reviewing case determinations from clients responding to a provider or member complaint
• Assist in case audits to assess the accuracy of Medical Directors’ decision making and adherence to the EviCore criteria and processes
• Assist in responding to notifications and requests to amend incorrect reviews when the physician reviewer who initially reviewed the case is not available
• Support sales and client management teams as clinical representative for designated program when requested by Executive Medical Director, Associate Chief Medical Officer, Chief Medical Officer, or General Manager
• Provide timely expert medical review of medical necessity requests for clinical services and renders a clinical opinion about the medical service under review, including post-decision reviews
• Provide timely and collegial peer-to-peer discussions with treating physicians to clarify clinical information and to explain review outcome decisions
• Document all actions related to clinical review sessions and attests to review qualifications as required
• Maintain necessary credentials and immediately informs EviCore of any adverse actions relating to medical licenses and/or board certifications
• Support the review and maintain updates of EviCore clinical guidelines
• Support and communicates EviCore policies and procedures to the provider community.
• Assist with staff educational training and in-service programs and serves as a clinical resource for EviCore staff
• Participate in all required educational and quality improvement activities and maintain passing scores in all assessments
• Minimum Education, Licensure and Professional Certification requirement:
• M.D. or D.O. degree from accredited institution.
• Minimum of five (5) years of clinical practice experience after completion of all graduate medical education training, including residency and fellowship (when applicable)
• Active board certification in medical or surgical specialty or subspecialty Other duties as assigned
• Minimum Experience required (number of years necessary to perform role):
• Two (2) or more years of managed care experience
• Familiarity with automated processes and computer applications and systems also required.
• Competencies:
• Instills Trust
• Manages Ambiguity
• Nimble Learning
• Develops Talent
• Drives Results
  
  

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 218,200 - 363,600 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 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 Evernorth Health Services

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. 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.