Medical Advisor

ESP Cigna European Services; Madrid; Presencial; EUR 60.000 - 90.000; Jornada completa

Descripción de la vacante

An established industry player in healthcare is seeking a dedicated Medical Advisor to join their Integrated Health Team. This role involves providing expert medical management services globally, ensuring quality care and customer satisfaction. The ideal candidate will leverage their extensive clinical experience and strong interpersonal skills to support diverse teams and improve health outcomes. Join a forward-thinking company that values cultural awareness and proactive problem-solving, making a significant impact on the lives of customers and clients alike. This position offers the opportunity to work remotely while collaborating with a multicultural population, driving innovation in health and wellness programs.

Formación

• 35 years of clinical experience, preferably in a payer setting.
• Experience in utilization management and medical claims revision.

Responsabilidades

• Provides medical management services to customers worldwide.
• Supports Case Management Team ensuring quality performance.

Conocimientos

Interpersonal Skills

Analytical Skills

Problem-Solving Skills

Fluency in English

Fluency in Spanish

Educación

Medical Doctor Degree

Herramientas

Microsoft Office

Medical Management Tools

Descripción del empleo

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 the attainment of quality, production, timeliness, customer advocacy, cost containment goals, and excellent customer satisfaction for both internal and external customers. In this role, the Medical Advisor would embrace Cigna's vision, culture, and values, representing the Integrated Health Team mission to our customers, clients, and stakeholders.

He/she works with a multicultural population and is constantly aware of cultural differences among that population and different geographical regions, combining healthcare global expertise with regional knowledge to better serve our customers, partners, and clients.

Ability to review, investigate, and respond to external and internal inquiries/complaints. Provides guidance and acts as a mentor or coach for nurses and other non-clinical staff.

Major responsibilities and desired results :

1. Makes part of the Integrated Health Team providing medical management services to customers worldwide.
2. Gives evidence-based advice on medical claims, taking into account internationally accepted protocols and local/regional customs and regulations.
3. Supports, coaches, and monitors the Case Management Team and Care Team through various Health and Clinical Case Management services and programs, ensuring quality performance, promoting optimal service delivery, and accurate reporting. Provides advice on corrective actions if necessary.
4. Assists in coordinating processes to improve quality of care and health outcomes for specific projects or populations.
5. Supports cost containment strategies and service delivery to meet yearly affordability goals.
6. Serves as a resource and educator, creating and implementing educational clinical programs for internal and external audiences, leveraging Cigna University resources.
7. Provides clinical advice to other functional areas, including:

• Underwriting Team: Clinical advice on underwriting processes and nondisclosure post-sale detection.
• Payment Integrity Team: Recommending best practices to prevent and detect fraud, waste, and abuse.
• Supporting Network Management Team.
• Collaborating with Health and Wellbeing Teams to develop wellness solutions.
• Working with Clinical Operations on quality improvement and clinical management projects.
• Supporting Client Management and Support Teams.
• Engaging with Sales and Marketing Teams.
• Participating in the business continuity plan to ensure operational continuity.
• Supporting urgent out-of-office requests from Care and Case Management Teams.
• Performing other duties as assigned.

Requirements :

• Medical Doctor Degree with international healthcare experience.
• 35 years of clinical experience, preferably in a payer setting on medical management.
• Experience in utilization management, case management, disease management, cost containment, insurance coverage, and underwriting. Experience with disease management programs and tools is advantageous.
• Experience in medical claims revision.
• Strong interpersonal and communication skills.
• Proactive problem-solving and analytical skills.
• Proficiency in operating a personal computer, including Microsoft Office, call center software, and other medical management tools.
• Ability to work remotely from home.
• Ability to build solid working relationships with staff, partners, clients, and healthcare providers.
• Stress resistance and efficiency, balancing quality and quantity.
• Fluency in English and Spanish; additional languages are a plus.

About Cigna Healthcare

Cigna Healthcare, a division of The Cigna Group, advocates for better health through every life stage. We guide our customers through the healthcare system, empowering them with information to make informed health decisions. Join us in driving growth and improving lives.

Qualified applicants will be considered regardless of race, color, age, disability, sex, childbirth, or related conditions, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, public assistance status, citizenship, or other protected characteristics.

If you require reasonable accommodation to complete the online application, please email us for support. Do not email for application updates or resume submissions, as responses will not be provided.