Encore Medical Director - Express Scripts

Job description

Medical Principal Job Description Encore Role- Cigna Retiree Program: Position scope: Primarily regional with national level case work for Cigna Healthcare (CHC) -- Cigna. Summary description of position : A Medical Principal performs medical review and case management activities. The physician provides clinical insight to the organization through peer review, benefit review, consultation, and service to internal and external customers. He/she will serve as a clinical educator and consultant to utilization management, case management, network, contracting, pharmacy, and service operations (claims). This is an entry to mid-level position for a physician interested in a career in health care administration. Major responsibilities and required results: - Performs benefit-driven medical necessity reviews for coverage, case management, and claims resolution, using benefit plan information, applicable federal and state regulations, clinical guidelines, and best practice principles. - Works to achieve quality outcomes for customers/members with a focus on service and cost - Improves clinical outcomes through daily interactions with health care professionals using active listening, educati...