The Cigna Group
Remote (Bloomfield, CT, USA)
Summary: The Medical Director provides timely expert medical review of medical necessity requests for clinical services that do not meet utilization review criteria and renders a clinical opinion about the medical service under review while located in a state or territory of the United States. Responsibilities include: Provide timely expert medical review of medical necessity requests for clinical services related to post-acute care and render 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. Participate in proactive peer to peers to assist with appropriate and timely discharge planning. Document all actions related to clinical review sessions and attest to review qualifications as required. Conduct weekly Case Conferences with nursing and social worker teams; discussing every...