Medical Director

The Cigna Group

. Perform benefit-driven medical necessity reviews for coverage, case management, and claims resolution .

Posted 9/30/2026full-timeRemote • United StatesLead💰 $212,600 - $354,300 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical necessity reviews, clinical management, and regulatory compliance while effectively communicating and negotiating with healthcare professionals. Maintains a strong focus on quality outcomes and customer advocacy in a managed care environment.

Highest-signal resume keywords

Current Unrestricted Medical LicenseBoard Certification in ABMS or AOA Specialty5+ Years of Clinical Practice ExperienceMedical Management and Utilization Review ExperienceProject Management in Fast-Paced Environment

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical Necessity ReviewsClinical Guidelines ApplicationQuality ImprovementEvidence-Based Clinical InformationRegulatory ComplianceCase ManagementUtilization ReviewData AnalysisClinical InsightPatient Care

Soft Skills

CommunicationNegotiationDecision-MakingProblem-SolvingTeamwork

Tools & Technologies

Word ProcessingSpreadsheetsEmailPowerPointPersonal Information Management Programs

Certifications & Qualifications

Current Unrestricted Medical LicenseBoard Certification

Industry Keywords

Managed CareClinical PracticeHealthcare Professional RelationsCulturally Diverse SituationsQuality Outcomes

About the role

Key responsibilities & impact

Perform benefit-driven medical necessity reviews for coverage, case management, and claims resolution
Use benefit plan information, federal and state regulations, clinical guidelines, and best-practice principles
Achieve quality outcomes for customers and members while focusing on service and cost
Improve clinical outcomes through interactions with health care professionals, including listening, education, communication, and negotiation
Balance customer/member needs with business needs while advocating for customers and members
Participate in all appropriate levels of the appeal process
Participate in coverage guideline development and medical management projects, initiatives, and committees
Participate in audits, inter-rater reliability clinical reviews, and quality projects
Mentor or coach Medical Directors and colleagues in quality and performance improvement
Improve health care professional relations through direct communication and evidence-based clinical information
Apply evidence-based guidelines, including novel treatments, to peer review across medical and behavioral health conditions
Maintain knowledge through monthly updates to Cigna coverage policies, inter-rater reliability testing, continuing medical education, and board certification maintenance
Address customer service issues with leadership support
Investigate and respond to client and regulatory questions
Support timely coverage reviews and quality outcomes for regulatory and accreditation compliance
Provide clinical insight and management support to functional areas and matrix partners

Requirements

What you’ll need

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
Minimum of 5 years of clinical practice experience and/or direct patient care beyond residency
Ethical and professional behavior
Competency in word processing, spreadsheets, 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
If working at home, internet connection through cable broadband or fiber optic service with at least 10 Mbps download/5 Mbps upload
Preferred: experience in medical management, utilization review, and case management in a managed care setting
Preferred: knowledge of managed care products and strategies
Preferred: experience managing multiple projects in a fast-paced matrix environment
Preferred: ability to educate colleagues and staff members
Preferred: change management experience
Preferred: teamwork, negotiation, conflict management, decision-making, and problem-solving skills
Preferred: ability to assess complex issues, determine and implement solutions, and resolve problems
Preferred: experience maintaining relations with diverse stakeholders
Preferred: sensitivity to culturally diverse situations
Service marketing, sales, and business acumen experience is a plus

Benefits

Comp & perks

Annual bonus eligibility
Long-term incentive plan eligibility
Medical benefits
Vision benefits
Dental benefits
Well-being and behavioral health programs
401(k)
Company-paid life insurance
Tuition reimbursement
Minimum of 18 days of paid time off per year
Paid holidays
Leaves of absence