Encore- Senior Medical Director

Medical Senior Director - Clinical Oversight - Encore (Cigna Retiree Program)

About our Team: The Cigna Healthcare Organization is comprised of trusted clinical leaders and subject matter experts in the market and across the enterprise.

Our customers and patients are at the center of all we do as we partner with external stakeholders and internal colleagues to achieve affordable care with the best clinical outcomes.

Role Summary:

Reporting to the CMO for Cigna Healthcare, the Medical Senior Director-Encore is a proven clinical leader who will provide ongoing ad hoc, consultative support for select high profile cases.

Responsibilities include high profile case review, data gathering/fact finding, and providing guidance on cases escalated, being brought to IRO, involving legal or media attention, etc.

This leader may be pulled in for expertise in other areas as needed.

Key Responsibilities:


* Provides clinical expertise and consultative support for high profile cases, including case review, data gathering/fact finding, and providing guidance to facilitate resolution


* Collaborates with internal stakeholders to assess and resolve high profile, complex cases


* Protects Cigna's brand through active involvement in case resolution


* Ensures compliance with all Federal, State, and other regulatory requirements, including Mental Health Parity in conjunction with other stakeholders


* Collaborates with and provides clinical support to Cigna Healthcare matrix partners including National Ancillary Contracting, Special Investigations Unit, Customer Experience and Product


* Provides guidance and acts as a mentor for Medical Management leadership

Key Competencies:


* Strategic Mindset


* Clinical Acumen


* Drives Results


* Ensures Accountability


* Collaborates


* Business Insight


* Courage


* Communicates Effectively

Requirements:


* Current board certification and unrestricted medical license in a US state or territory, MBA preferred


* 5+ years of clinical experience in a payer setting with a background in leadership


* Combination of clinical expertise and business acumen, with experience in driving affordability through clinical outcomes


* Experience in utilization/case management, claim data analytics, health services/managed care


* Strategic thinker, who can establish and translate business objectives into an actionable solution approach, execution, and results


* Experience working across organizational boundaries, particularly forming strong partnerships across multiple business units


* Embrace and lead change effectively and cultivate an environment of customer centricity, innovation, and continuous improvement


* Strong interpersonal and communication skills, demonstrates pro-active problem-solving, presentation, negotiation and analytical skills


* Demonstrated sensitivity to culturally diverse situations, participants, and customers/member...