Medical Advisor

Cigna Job Specification

Position Title: Medical Advisor

Job Purpose:

The Medical Advisor (MA) is a member of the medical team which develops and manages health and wellness programs for Cigna customers. Together with a team of nurses and physicians this role will ensure attainment of quality, production, timeliness, cost containment goals, and excellent customer satisfaction for both internal and external customers. Ability to review, investigate, and respond to external and internal inquires/complaints. Provides guidance and acts as a mentor or coach for the nurses and other non-clinical staff.

Reports to: Senior Medical Director - Americas

Critical Tasks and Expected Contributions/Results:

• Provides expert content/professional leadership on complex medical direction assignments/projects.
• Assists medical director in providing professional guidance and assistance in the evaluation of medical factors of proposed risks.
• Commits on approval of applications within specified limits on medical underwriting to assure best possible risk selection.
• Assists medical director in coordinating the basic functions inherent in the major operations of medical criteria for selection of risks and evaluation of medical examiners, and liaison with medical information and service organizations.
• Prescribes procedures and interpretations of laboratory, EKG, and X-ray results involved in risk appraisal.
• Exercises considerable creativity, foresight, and judgment in conceiving, planning, and delivering initiatives.
• Uses deep professional knowledge and acumen to advise functional leaders.
• Focuses on providing thought leadership within Medical Direction but works on broader projects, which require understanding of wider business.
• Recognized internally as a subject matter expert.
• Provides medical management services to customers worldwide
• Give evidence-based advice on medical claims, taking into account internationally accepted protocols and local and/or regional customs and regulations.
• Supports and monitors case management, disease management and other clinical services
• Assures quality of performance against QA standards to promote optimal service delivery and ensure accurate statistical data and reports. Gives advice on appropriate corrective action if necessary.
• Assists in fraud detection.
• Assists coordination of processes for improving quality of care and health outcomes for specifically delineated projects or populations.
• Assists and supports clinical team in cost containment, projects and service delivery to meet goals.
• Works with the team on quality improvement and clinical management projects within Clinical Operations
• Creates and fosters culture of clinical excellence, psychological safety, inclusion.
• Ad hoc projects or tasks as required

Key Challenges/Anticipated Changes in Environment:

• Able to apply sound clinical decision making based on evidence based medicine and best practices to myriad functions including medical review, case review, medical support for client, sales, finance, underwriting functions.
• Manages the different needs of diverse customers and providers
• The Med Advisor works with a multicultural population and is constantly aware of the cultural differences among that population and the geographical regions.

Developmental Value of Position:

• Be the go-to person who provides guidance and acts as a mentor or coach for the nurses and other non-clinical staff.
• Part of a clinical team that provides medical management services to customers worldwide
• Give evidence-based advice on medical claims, taking into account internationally accepted protocols and local and/or regional customs and regulations.
• Support and monitor the case management, disease management and other clinical services and assure quality of performance against QA standards to promote optimal service delivery and ensure accurate statistical data and reports. Give advice on appropriate corrective action if necessary.
• Assist in fraud detection.
• Assist is the coordination of processes for improving quality of care and health outcomes for specifically delineated projects or populations. Excellent communication and facilitation skills are keys to success.
• Assist and support the team in cost containment, assist in projects and service delivery to meet goals.
• Work together with the team on quality improvement and clinical management projects within Clinical Operations
• Serves as a resource/educator regarding specific areas of expertise. Able to create and implement appropriate educational clinical programs content for internal and external audiences and link with Cigna University resources.
• Other duties as assigned

Experience/Knowledge, Education and Other Requirements:

• Active medical license in US or other country (e.g. country of residence)
• Active board certification in US or other country
• At least five years clinical experience.
• Insurance industry experience: case management, utilization/medical necessity review, appeals.
• Understands and work w/ commercial, strategic, pricing, underwriting, sales, client management lines of business.
• Global experience.
• Strong command of written and verbal English; comfortable presenting to internal and external audiences.
• Training and experience with one of the following: aeromedicine, anesthesiology/critical care, emergency medicine, or travel medicine.
• Experience with aeromedical evacuations, global assistance.

Personal Competencies Required:

• Ability to work with a multicultural population and is constantly aware of the cultural differences among that population and the geographical regions.
• High Emotional Quotient; conflict resolution skills.
• High degree of discretion from patient and organizational confidentiality perspectives.

About The Cigna Group

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.