The Medical Advisor is a member of the medical team, part of IHT, who develops and manages health and wellness programs for Cigna customers. Together with a team of nurses and physicians she/he will ensure attainment of quality, production, timeliness, customer advocacy, cost containment goals, and excellent customer satisfaction for both internal and external customers. In his role, the Medical Advisor would embrace Cigna’s vision, culture and values, representing Integrated Health Team mission in front of our customers, clients and other external and internal stakeholders.
He/she works with a multicultural population and is constantly aware of the cultural differences among that population and the geographical regions, combining health care global expertise with regional knowledge to better service our customers, partners and clients.
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.
Major responsibilities and desired results:
- Makes part of Integrated Heatlh Team, providing medical management services to customers worldwide
- Gives evidence-based advice on medical claims, taking into account internationally accepted protocols and local and/or regional customs and regulations.
- Supports, coaches, and monitors the Case Management Team and Care Team through our different Health and Clinical Case Management services and programs. Ensuring quality of performance, promoting optimal service delivery and accurate reporting. Gives advice on appropriate corrective action if necessary.
- Assist in the coordination of processes for improving quality of care and health outcomes for specifically delineated projects or populations.
- Assist and support the team’s cost containment strategy, projects, and service delivery to meet our yearly affordability goals.
- 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.
- Assists other functional areas:
- Underwriting Team, providing clinical advise on Underwriting processes and non-disclosure post-sale detection
- Payment Integrity Team:
- Providing clinical advice and recommending best practices to prevent and detect fraud, waste and abuse.
- Providing support to our Network Management Team.
- Health and Wellbeing Teams: Collaborating to develop, implement and deploy wellness solutions.
- Clinical Operations: Work together with the team on quality improvement and clinical management projects.
- Client Management and Client Support Teams
- Sales and Marketing Teams
- LPS team
- Makes part of the business continuity plan to ensure operational continuity to our customers
- Supports emergent/urgent out of office hours requests from Care Team and Case Management Team where MNR services are required.
- Other duties as assigned
Requirements:
- Medical Doctor Degree with international healthcare experience
- 3-5 years of clinical experience preferable in a payer setting on medical management
- Experience in utilization management, case management, disease management, cost containment, insurance coverage and underwriting. Experience on disease management programs and tools is an advantage
- Experience in medical claims revision
- Strong interpersonal and communication skills
- Pro-active problem-solving and analytical skills.
- Ability to operate a personal computer, proficient with Microsoft office products, call center software, and a variety of software for medical management.
- Ability to work remotely, working from home
- Ability to build solid working relationships with staff, matrix partners, clients, customers and healthcare providers
- Stress resistant and efficient, finding a good balance between quality and quantity
- Ability to speak, write and read English and any other languages are an advantage
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