Medical Director (Remote)

Randstad (Schweiz) AG; Tennessee; Remote; USD 200,000 - 300,000; Full time

Job summary

A leading healthcare company is seeking a Medical Director to enhance clinical reviews and processes for their Medicare Supplement products. The role involves collaboration with various teams, overseeing clinical operations, and developing innovative strategies for cost containment. Ideal candidates will be board-certified physicians with extensive clinical experience and strong leadership skills.

Qualifications

• Board-certified physician with an active, unrestricted medical license.
• At least 10 years of clinical practice experience.
• Ability to obtain necessary state licenses.

Responsibilities

• Provides clinical expertise and support across departments related to Cigna's Medicare Supplement products.
• Oversees the Supplemental Benefits Clinical Team (SBCT).
• Collaborates with actuarial teams on underwriting, pricing, claims automation, and cost analysis.

Skills

Teamwork

Communication

Negotiation

Conflict Management

Problem Solving

Decision Making

Presentation Skills

Analytical Skills

Education

Board-certified physician

MBA or equivalent experience

Tools

Data Science

Job description

We're Hiring: Medical Director!

Open to candidates in IL, TX, NM, OK, MT, TN, and AL.

Schedule: M-F, up to 40 hours per week (at least 32 hours per week).

Preferred Qualifications: Internal Medicine, Geriatric, or Family Practitioner with computer experience, presentation skills, case management, and appeal review experience.

Job Title:

Cigna Supplemental Benefits (CSB) Medical Director

Job Summary

The CSB Medical Director will collaborate with the National Medical Director and CSB leadership to enhance clinical reviews and processes, implement new innovations, and engage clinical expertise across the enterprise.

Key Job Functions

1. Provides clinical expertise and support across departments related to Cigna's Medicare Supplement (Medigap) and SHL insurance products.
2. Ensures strategic and tactical delivery of projects for supplemental health products across 49 states and DC.
3. Offers clinical resources and education to multidisciplinary teams supporting underwriting, claims, appeals, rescissions, and fraud cases.
4. Oversees the Supplemental Benefits Clinical Team (SBCT), including Medical Directors, pharmacists, data analysts, and other members.
5. Collaborates with actuarial teams on underwriting, pricing, claims automation, and cost analysis.
6. Contributes to developing innovative tactics to improve cost containment, such as preventive care and vendor solutions.

Minimum Qualifications

Education & Experience: Board-certified physician with an active, unrestricted medical license and at least 10 years of clinical practice. Ability to obtain necessary state licenses.

Competencies & Skills

• Experience with Medigap, supplemental insurance, and medical underwriting preferred.
• MBA or equivalent experience preferred.
• Ability to assess complex issues, recommend changes, and resolve issues.
• Strong skills in teamwork, communication, negotiation, conflict management, problem solving, and decision making.
• Experience in educating clinical and non-clinical staff.
• Proficient computer skills; data science background is a plus.
• Strategic thinking, analytical skills, and decision-making capabilities.
• Experience delivering presentations to diverse audiences, including senior management.
• Ability to work independently and under pressure.
• Excellent interpersonal skills and collaborative mindset.

Ready to make an impact? Apply now and let’s grow together!