The Cigna Group

The Lead Analyst will manage invoice review and audit processes for Coverage Review Operations, ensuring accuracy and compliance of invoices from Global Service Partners. This role involves collaboration with finance, procurement, and accounts payable teams to resolve discrepancies and streamline processes. | A high school diploma is required, with a preference for a bachelor's degree. Candidates should have at least 2 years of experience in invoice review or auditing, along with strong analytical and communication skills. | The job profile for this position is Pharmacy Prior Authorization Lead Analyst, which is a Band 3 Senior Contributor Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply! Our people make all the difference in our success. Job Description: The Lead Analyst - Invoice Review and Audit will be responsible for Coverage Review Operations (CRO) Global Service Partners (GSP) Invoice management by: Ensuring the accuracy and compliance of invoices received from various GSPs and third-party suppliers. Performing comprehensive review, auditing, and approval of invoices. Ensuring adherence to company policies and contract terms. The Lead Analyst will work closely with the finance, procurement, and accounts payable teams to streamline processes and resolve any discrepancies. Key Responsibilities: Review and verify the accuracy of invoices and supporting documents. Ensure invoice amounts align with monthly budget allocations and forecasted spend (volume/hours/FTE) Audit invoices to ensure compliance with contract terms, company policies, and regulatory requirements. Track and report on total invoice amounts, trends, variances to support budget visibility and decision making Approve invoices in Ariba for payment, ensuring timely and accurate processing. Provide regular updates to business leaders on invoice status, pending approvals, and payment timelines Identify and resolve discrepancies or issues with invoices by collaborating with GSPs (Global Service Provider) along with Business and Operational Stakeholders. Support governance reporting needs by providing invoice data insights as needed Maintain detailed records of invoice reviews and audits, ensuring proper documentation and traceability. Develop and implement best practices for invoice review and audit processes. Manage and maintain CRO Term Sheets: Establish cadence to review and ensure Term Sheets are accurately funded for the life of the GSP Contract. Validate the Term Sheet are active during the life of the contract. Collaborate with the finance and procurement teams to resolve invoice or Term Sheet issues. Support CRO Business and Operational stakeholders by scheduling ad hoc meetings with GSPs to resolve invoice discrepancies. Miscellaneous items to support and manage CRO GSP initiatives and projects Qualifications: High School Diploma Required ; Bachelor’s degree preferred Intermediate to Advanced Excel experience required 2+ experience in invoice review or auditing role required Excellent communication skills; both written and oral Strong interpersonal skills; must be able to collaborate with internal cross-functional teams to resolve issues timely. Excellent analytical and problem-solving skills. Attention to detail and accuracy in reviewing and auditing invoices; must be able to track issue progress and perform follow-ups timely. Proficiency in using financial software and Microsoft Office Suite (Excel, Word, PowerPoint) Ability to work independently and as part of a team. Preferred Qualifications: Experience in invoice processing or accounts payable, preferably in a BPO or vendor-managed environment valuable. Familiarity with ARIBA / Oracle. Experience working with vendors and third-party suppliers. Certification in auditing or accounting (e.g., CPA, CIA) is a plus. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 56,800 - 94,600 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Conduct evidence-based medical case reviews and physician consultations remotely to ensure appropriate patient care in Pain Medicine. | MD or DO with active US medical license, board certified in Pain Medicine, 3+ years clinical experience post residency/fellowship, strong computer skills, and ability to work remotely with secure internet. | Do you crave an intellectually stimulating job that allows you to leverage your clinical expertise while developing new skills and improving the lives of others? Then look no further! As a Pain Medicine Medical Director at EviCore, part of Evernorth Health Services, a division of The Cigna Group, you’ll use your clinical know-how to provide evidence-based medical reviews for patient care. Collaborate with healthcare providers and stay current on healthcare regulations and industry developments as you review a wide range of cases. This role offers you the opportunity to build new skills while enhancing the health and vitality of others. We're seeking a detail-oriented individual with good communication, technology, and typing skills, as well as strong clinical judgment. Drive growth in your career with our innovative team. How you’ll make a difference: You’ll start training remotely in a structured environment with support from trainers, mentors, and leadership to set you up for success. Complete time-sensitive, specialized evidence-based medical case reviews for medical necessity on EviCore’s case management software. Conduct physician consultation (peer-to-peer) calls with referring providers to discuss evidence–based medical necessity and appropriateness of the requested service or treatment. Leverage your clinical expertise to recommend alternative services or treatments as necessary. Work collaboratively with over 500 EviCore physician colleagues to help ensure patients receive proper care via evidence-based decision making. What you’ll enjoy about working here: Benefits start on day one Predictable work schedules 100% work from home 8 Paid Holidays + 23 PTO Days 401(K) with company match Reimbursement for continuing medical education Career growth opportunities across the enterprise Networking with peers across multiple medical specialties Requirements: M.D. or D.O. with a current, active, U.S. state medical license and board certified in Pain Medicine, recognized by the American Board of Medical Specialties, or American Osteopathic Association Eligible to acquire additional state licensure as required 3 years of relevant clinical experience post residency/fellowship Knowledge of applicable state federal laws Utilization Review Accreditation Commission and National Committee for Quality Assurance standards is a plus Ability to commit to a set, weekly work schedule (Monday through Friday) Strong computer skills: ability to work autonomously with automated processes, computer applications, and systems Meet physical demands of the role including, but not limited to, typing, speaking, and listening 100% of time In accordance with our HITECH Security Accreditation, company provided encrypted-workstation is required to be hard-wire connected to a modem or router. Wireless connection is not permitted. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 203,200 - 338,600 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group. About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Provide expert medical review of utilization requests, conduct peer-to-peer discussions, support discharge planning, maintain credentials, and assist with staff education and clinical guideline review. | MD or DO degree, active unrestricted medical license, board certification in Physical Medicine and Rehabilitation, minimum 3 years clinical practice post-training, knowledge of utilization management standards, and ability to work a set weekly schedule. | The job profile for this position is Utilization Review Medical Principal, which is a Band 5 Senior Contributor Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply! Our people make all the difference in our success. 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 assigned member receiving care in a post-acute care facility, focusing on discharge planning, complex medical care management, quality of care, appropriate level of care, and appropriate length of stay. Maintain necessary credentials and immediately inform eviCore of any adverse actions relating to medical licenses and/or board certifications. Support the review of eviCore clinical guidelines. Support and communicate eviCore policies and procedures to the provider community. Testify at ALJ Hearings when your cases are being appealed Assist with staff educational training and in-service programs and serve as a clinical resource for eviCore staff. Serve as a Subject Matter Expert when Medical Directors and/or Senior Medical Directors are unavailable. Available for scheduled weekend call from home based on business needs. Participate in Joint Operating Committee (JOC) meetings, including the collection and review of data relevant to the client, and other virtual events with the provider engagement team in your specified territory. Participate in all required educational and quality improvement activities and maintain passing scores in all assessments. Assist in reviewing case determinations from clients responding to a provider or member complaint Maintain necessary credentials and immediately inform eviCore of any adverse actions relating to medical licenses and/or board certifications Other duties as assigned Minimum Education, Licensure and Professional Certification requirement: M.D. or D.O. degree from accredited institution. Minimum of three (3) years of clinical practice experience after completion of all graduate medical education training, including residency and fellowship (when applicable) Active board certification in Physical Medicine and Rehabilitation required Active unrestricted license to practice medicine in a state or territory of the United States as a utilization review doctor of medicine or doctor of osteopathic medicine. Knowledge of applicable state and federal laws, URAC and NCQA standards, and utilization management Ability to commit to a set, weekly work schedule (Monday through Friday) Strong computer skills: ability to work autonomously with automated processes, computer applications, and systems Meet physical demands of the role including, but not limited to, typing, speaking, and listening 100% of time In accordance with our HITECH Security Accreditation, company provided encrypted-workstation is required to be hard-wire connected to a modem or router. Wireless connection is not permitted. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 203,200 - 338,600 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Handle inbound calls from patients to learn about their medical history and challenges with fertility. Coordinate fertility plans and medications while ensuring a positive patient experience through effective issue resolution. | A high school diploma or GED is required along with excellent customer service and organizational skills. Candidates should be able to multitask and have proficiency in Microsoft Office Suite. | Ready for a job that encourages you to use your communication and problem solving skills? If so, prepare to use those skills to help your patients’ dreams of having a family come true! As a Customer Service Associate Representative at Freedom Fertility, you’ll use your empathy and listening skills to handle inbound calls from patients and learn more about their medical history and challenges with fertility. This is not your average customer service job – you’ll work for a company that truly cares about people while helping our patients achieve happiness. Here’s a little more on how you’ll make a difference: Ensure process efficiency – Work with both patients and physicians to coordinate fertility plans and medications. Own the patient experience through resolving customer issues and ensuring 100% follow-up to customers. Pay attention to detail – Accurately obtain and enter patient information, including shipping, insurance and payment information. Be a team player – Escalate complex claims to the appropriate team for further action. Why join us? Health coverage effective day 1 (including medical, dental, vision) Holiday, PTO and OT pay 401K with company match Tuition reimbursement Fun, friendly and unique culture – bring your whole self to work every day! What you need to do the job: An empathetic and fun-loving personality with a few good jokes on the ready High School Diploma or GED required Excellent customer service, organization and time management skills Multitasking - Operating several systems at once PC skills including knowledge of Microsoft Office Suite (Outlook) and Internet If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an hourly rate of 17.75 - 19 USD / hourly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Develop and execute strategic event plans, manage logistics for client-facing events, collaborate across teams, lead special projects, and support internal communications. | Bachelor’s degree with 5+ years in business planning, communications, or corporate events, strong strategic thinking and organizational skills, excellent communication, and willingness to travel. | Position Overview: The Events and Communications Lead Analyst plays a key role in supporting the Health Plan Account Management, Growth, and Regulated Markets teams by delivering high-impact client experiences through strategic event planning and communications. This role ensures alignment between event strategy and business objectives, enhancing client engagement and brand consistency. Key Responsibilities: Develop and execute strategic event plans aligned with business goals and audience needs. Manage logistics for client-facing events (e.g., conferences, lab visits, onsite meetings), including travel, catering, room setup, briefing materials, and site visits. Collaborate with cross-functional teams (leadership, marketing, communications, events COE) to ensure seamless execution. Propose innovative event formats to enhance engagement and brand experience. Conduct pre - and post-event evaluations, including surveys and debriefs, to identify improvements. Lead special projects such as custom member satisfaction surveys and team meetings. Support internal communications and presentation development across the division. Monitor industry trends to inform event strategy and execution. Qualifications: Bachelor’s degree with 5+ years of experience in business planning, communications, or corporate events. Healthcare experience is a plus. Proven ability to link event outcomes to business growth, efficiency, and client loyalty. Strong strategic thinking, project management, and organizational skills. Excellent communication and interpersonal abilities across all organizational levels, including senior leadership Proficiency in Microsoft Excel, Word, and PowerPoint; basic graphic design skills a plus. Willingness to travel (15–20%) and work occasional off-hours. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 76,400 - 127,300 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group. About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Lead strategy development and execution for Dental & Vision business, drive innovation and competitive intelligence, manage business projects, and support leadership in operational management. | Bachelor’s degree required, advanced degree preferred, 10+ years in strategy/product strategy, experience in dental/vision health insurance, strong leadership and communication skills. | The job profile for this position is Strategic Planning Senior Director, which is a Band 5 Management Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply! Our people make all the difference in our success. Job Summary As a member of the Dental & Vision leadership team, the Strategy, Execution & Innovation Lead will drive efforts to identify and oversee the development, implementation, and sustainment of strategies to grow and differentiate Cigna Dental & Vision solutions. Reporting to the VP of Dental & Vision, the role is accountable to shape long-term business strategy by partnering closely with teams across the value chain to understand stakeholder needs and the broader external environmental forces impacting the marketplace. The role will drive focus and transparency into progress against priorities, bring capability needs through the Enterprise Portfolio process, and successfully deliver enhancements in pursuit of business goals. In addition, the role will be responsible for all innovation and competitive intelligence analysis for the business. Duties & Responsibilities Key activities include, but are not limited to, the following: Strategy development and communication Drives the annual strategy process, including communication of business strategy to all levels of the organization. Leads competitive Intelligence and other market-facing teams to understand market trends and developments, and the influence on strategic assumptions and direction. Works closely with technology and functional-area partners to drive strategic alignment between business and technology roadmaps. Ensures that Dental & Vision activities are aligned with Cross-Enterprise initiatives and strategies. Project delivery Drive Dental & Vision participation in the Enterprise Portfolio process: Advocate for annual Enterprise Portfolio investments in Dental & Vision, ensuring strong business cases and N-1 prioritization for capability needs. Analysis of new capabilities and enhancements, including feasibility review, business case creation, and related business and technical analysis in support of Agile project mobilization and delivery. Oversight of business project delivery in close partnership with Agile delivery teams, including but not limited to business readiness and change management activities. Ownership of business intake process, evaluating annual and ad-hoc requests for business value and relative priority. Insights & Innovation Lead Enable and guide the ongoing assessment of market conditions, early stage companies and new technologies across the oral care and vision ecosystems to unearth and consider opportunities aligned with the strategy, interest and of value to Cigna. Partner with Cigna and Evernorth personnel in similar capacity across other solution lines to understand broader Enterprise innovation strategies and tactics, seeking aligned and synergistic opportunities. Guide a disciplined approach to testing and evaluating potential B2B relationships. Responsible for creating, promoting and delivering a culture and mindset of innovation throughout the dental & vision organization. Provide oversight and manage deployment of innovation funds in the identification, assessment and deployment of high potential and impactful solutions. Develop market insight capabilities, and as part of Dental Senior Leadership, leverage those insights to inform the company’s strategy, growth objectives and plan execution. Provide market insights that inform matrix stakeholders of key competitor capabilities, supporting accelerated growth. Guide business intelligence best practices in a bi-directional basis with Enterprise resources tasked with similar business intelligence responsibilities. Vision Product Business Lead Lead growth strategy for our Vision product (currently $30M Earnings/3 Million customers) Manage the overall relationship with EyeMed (our primary vision vendor) Partner with Buyer group leadership (National and U3000) to grow size of Vision as a part of the broader USE portfolio of products. Identify, champion, and implement new capabilities required to support growth. Chief of Staff & Management process lead Supports the VP of Dental & Vision to manage and execute the operating model, connecting all functions/teams to the overall Dental & Vision priorities and strategies. Drives annual creation of goals and key priorities for Dental & Vision line of business. Leads a management process that drives transparency into progress towards goals and initiatives, highlighting leading + lagging indicators of business performance, and driving consistent messaging across all levels of the organization. Creates scorecards and exhibits to track and report business health and performance. Ensures content is developed and aggregated for effective meeting management. Coordinates weekly, monthly, and quarterly team meetings, town halls, executive business reviews, and other ad-hoc meetings as necessary. Drives decision-making & alignment, escalating risks and opportunities. Qualifications, Knowledge, and Skills Bachelor’s degree required and advance degree preferred. Prior experience with a Dental/Vision health insurer required. 10+ years in Strategy Development, Execution and/or Product Strategy. Successful experience managing complex initiatives to completion in a highly matrixed environment. Self-starting leader that exhibits high levels of emotional intelligence and strong interpersonal skills. Ability to work independently while being thoughtfully collaborative. Strong written and verbal communications skills. Ability to clearly articulate messages to all levels of the organization. Able to develop and articulate a clear strategic vision and see through fruition. Willing to challenge the status quo with new ideas, approaches and solutions. Effectively pivots between strategic development and tactical deployment. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

The Quality Review and Pharmacy Technician Audit Lead Analyst is responsible for identifying pharmacy audit risks and developing audit plans to address those risks. They will conduct audits, present findings, and mentor less experienced team members. | Candidates should have at least 2 years of pharmacy technician experience and preferably hold a Bachelor's Degree or equivalent. Proficiency in database and spreadsheet applications, along with excellent communication and organizational skills, is essential. | The job profile for this position is Quality Review and Audit Lead Analyst, which is a Band 3 Senior Contributor Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply! Our people make all the difference in our success. ***Location: Candidate must be located in the Minneapolis-Saint Paul metro area and must be willing to travel for pharmacy audits up to 50% of the time.*** POSITION SUMMARY: The Quality Review and Pharmacy Technician Audit Lead Analyst is responsible to identify pharmacy audit risks using analytical skills and audit tools and develop and execute audit plans and scope of procedures determined necessary to address those risks. They will complete audits in order to correct risks identified and present findings to the Sr Audit Manager. They may participate in third party audits and work collaboratively with cross functional partners to complete research needed and provide background knowledge needed to interpret audit scope. As a Staff Auditor, this position may act as a resource for less experienced team members and work on special projects as needed. This role will function as support of the Sr. Manager- Audit on some escalated issues and projects. ESSENTIAL FUNCTIONS: Perform efficient and effective audits to produce results consistent with departmental policies and critical corporate goals while meeting or exceeding personal production goals. Performance of audits includes obtaining, analyzing, and appraising evidentiary data on which to base an informed, objective assessment of the accuracy and legitimacy of claims audited. Utilize personal knowledge of medications and available tools including the Enterprise Data Warehouse (EDW), Access, Excel, etc., identify pharmacies and claims representing audit risks and develop an audit plan, utilizing appropriate audit techniques, to efficiently and effectively address those risks. Develop and produce reports as required to meet needs of department management, Account Managers, pharmacies and chain audit contacts, clients and other stakeholders. Providing updates to management on current status of audits including any escalated issues. Prepare for and participate in client communications, including conference calls and on-site meetings, to present status updates of ongoing issues, results of completed audits, etc., for assigned clients. Perform special projects as assigned. Mentor less experienced team members to improve their understanding and skills by ensuring they are familiar with resource materials including manuals and systems. Responsible for the training of new associate auditors on departmental processes. Assist with post audit as required by management. IDEAL CANDIDATES WILL HAVE A COMBINATION OF THE FOLLOWING: Bachelor's Degree or equivalent work experience preferred At least 2+ years of pharmacy technician experience in a retail, long term care, specialty, mail order or similar pharmacy setting or equivalent education. Certified Pharmacy Technician (CPhT) preferred. Proficient in database and spreadsheet applications, ie: Microsoft Excel, Access, Word. Excellent organizational, interpersonal, and communication skills. Ability to work well with all levels of internal and external contacts. Ability to handle sensitive or confidential information is critical. Ability to work with minimum management oversight while performing audits. Ability to work a flexible schedule to accommodate project deadlines. Ability and willingness to travel up to 50%. Reliable transportation for local travel for field audits within the Minneapolis-Saint Paul metro area Valid Driver's license required. ABOUT THE DEPARTMENT: The Pharmacy Operations Group is crucial to achieving our mission of helping to achieve a more sustainable health care system and better health for all. Members of this team are on the front line every day – interacting with patients, strategizing on improvements and efficiencies, and processing more than one million prescriptions that come through our world-class pharmacies and distribution facilities across the country. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 67,200 - 112,000 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Perform evidence-based medical case reviews and physician consultations to ensure appropriate patient care in sleep medicine. | Must have MD or DO with active US medical license, board certification in Sleep Medicine, 3 years clinical experience, and ability to work remotely with strong computer skills. | The job profile for this position is Utilization Review Medical Principal, which is a Band 5 Senior Contributor Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply! Our people make all the difference in our success. Do you crave an intellectually stimulating job that allows you to leverage your clinical expertise while developing new skills and improving the lives of others? Then look no further! As a Sleep Medicine Medical Director at EviCore, part of Evernorth Health Services, a division of The Cigna Group, you’ll use your clinical know-how to provide evidence-based medical reviews for patient care. Collaborate with healthcare providers and stay current on healthcare regulations and industry developments as you review a wide range of cases. This role offers you the opportunity to build new skills while enhancing the health and vitality of others. We're seeking a detail-oriented individual with good communication, technology, and typing skills, as well as strong clinical judgment. Drive growth in your career with our innovative team. How you’ll make a difference: You’ll start training remotely in a structured environment with support from trainers, mentors, and leadership to set you up for success. Complete time-sensitive, specialized evidence-based medical case reviews for medical necessity on EviCore’s case management software. Conduct physician consultation (peer-to-peer) calls with referring providers to discuss evidence–based medical necessity and appropriateness of the requested service or treatment. Leverage your clinical expertise to recommend alternative services or treatments as necessary. Work collaboratively with over 500 EviCore physician colleagues to help ensure patients receive proper care via evidence-based decision making. What you’ll enjoy about working here: Benefits start on day one Predictable work schedules 100% work from home 8 Paid Holidays + 23 PTO Days 401(K) with company match Reimbursement for continuing medical education Career growth opportunities across the enterprise Networking with peers across multiple medical specialties Requirements: M.D. or D.O. with a current, active, U.S. state medical license and board certified in Sleep Medicine, recognized by the American Board of Medical Specialties, or American Osteopathic Association Eligible to acquire additional state licensure as required 3 years of relevant clinical experience post residency/fellowship Knowledge of applicable state federal laws Utilization Review Accreditation Commission and National Committee for Quality Assurance standards is a plus Ability to commit to a set, weekly work schedule (Monday through Friday) Strong computer skills: ability to work autonomously with automated processes, computer applications, and systems Meet physical demands of the role including, but not limited to, typing, speaking, and listening 100% of time In accordance with our HITECH Security Accreditation, company provided encrypted-workstation is required to be hard-wire connected to a modem or router. Wireless connection is not permitted. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 203,200 - 338,600 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

The Provider Services Lead Analyst is responsible for managing the overall provider experience and service delivery for a medium to low complex book of business. This role involves collaborating with matrix partners to drive service improvements and resolve service impacts. | A Bachelor's Degree or equivalent work experience is preferred, along with at least 3 years of experience in provider relations. Candidates should possess excellent communication skills and a solid understanding of managed care operations. | The job profile for this position is Provider Relations Lead Analyst, which is a Band 3 Senior Contributor Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply! Our people make all the difference in our success. Due to the Book of Business, we are planning to hire a candidate near the Glendale, CA area. SUMMARY This position is an external provider facing role with account management responsibilities for a medium to low complex book of business. The role is accountable for the overall provider experience by working in collaboration with matrix partners to drive on-going service improvements, understand, articulate and resolve service impacts, and drive the overall provider strategic planning solutions. This individual is empowered within their scope to make decisions as it pertains to the experience with Cigna, is required to have local market knowledge and visibility, builds and continuously improve the relationship between Cigna and the provider. DUTIES AND RESPONSIBILITIES Accountable for the end-to-end provider experience and overall service delivery for assigned Book of Business aligned to medium to low complex providers Leads, collaborates, and supports local market direction as it relates to improving the provider experience Creates and maintains individual provider strategic action plans Proactively identify new opportunities and risks for providers at market or national level and drives resolution Exercises good judgment and discretion to support the provider experience Responsible for capturing, documenting, and sharing market intelligence; use market intelligence to develop and drive strategic improvements External facing with providers in assigned BOB Collect, analyze, interpret, translate and distribute provider informatics, reports, dashboards Track and monitor performance guarantees for assigned BOB Promotes Provider Index score improvement through proactive and effective service and support of network Review provider reports/dashboard with individual providers Proactively educate providers on Cigna's business objectives, standard operating procedures, policies and programs to influence behavior and how to work with Cigna Serve as a provider advocate both internally and externally Understands and applies service culture principles and methodology Serves as a provider advocate both internally and externally Serves in a consultative role or subject matter expert to key matrix partners Develops and participates in presentations to existing and prospective providers and/or clients Serves as advocate in external community, representing CIGNA to medical societies and external provider associations. Manage joint operating committees, including agenda development, facilitating appropriate meeting participation and follow up activities QUALIFICATIONS Bachelor's Degree or higher strongly preferred or equivalent work experience required 3+ years of experience in provider relations required Demonstrated excellent oral, written, interpersonal, analytical, and negotiation skills. Intermediate experience with MS Office (Word, Excek, Outlook, PowerPoint) Solid understanding of managed care/provider operations Ability to work in a matrix environment. Up to 25% travel may be required CORE COMPETENCIES Organizational savvy Plans and aligns Collaborates Communicates Effectively Interpersonal Savvy Tech Savvy Being Resilient Action oriented Decision quality Customer Focus Builds Networks Instills Trust If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 65,500 - 109,100 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

The Risk Adjustment Quality & Review Analyst evaluates complex medical conditions and determines compliance of medical documentation while identifying trends and suggesting improvements. They conduct medical records reviews, perform audits, and collaborate with team members to ensure compliance with coding guidelines. | Candidates must have a high school diploma and at least 2 years of experience with relevant coding certifications. Familiarity with CMS regulations and proficiency in medical documentation audits are also required. | The job profile for this position is Quality Review and Audit Analyst, which is a Band 2 Senior Contributor Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply! Our people make all the difference in our success. Job Summary: The Risk Adjustment Quality & Review Analyst in IFP brings medical coding and Hierarchical Condition Category expertise to the role, evaluates complex medical conditions, determines compliance of medical documentation, identifies trends, and suggests improvements in data and processes for Continuous Quality Improvement (CQI). Key Job Functions: • Conduct medical records reviews with accurate diagnosis code abstraction in accordance with Official Coding Guidelines and Conventions, Cigna IFP Coding Guidelines and Best Practices, and any additional applicable rule set. • Utilize HHS’ Risk Adjustment Model to confirm accuracy of Hierarchical Condition Categories (HCC) identified from abstracted ICD-10-CM diagnosis codes for the correct Benefit Year. • Apply longitudinal thinking to identify all valid and appropriate data elements and opportunities for data capture, through the lens of HHS’ Risk Adjustment. • Perform various documentation and data audits with identification of gaps and/or inaccuracies in risk adjustment data and identification of compliance risks in support of IFP Risk Adjustment (RA) programs, including the Risk Adjustment Data Validation (RADV) audit and the Supplement Diagnosis submission program. Inclusive of Quality Audits for vendor coding partners. • Collaborate and coordinate with team members and matrix partners to facilitate various aspects of coding and Risk Adjustment education with internal and external partners. • Coordinate with stake holders to execute efficient and compliant RA programs, raising any identified risks or program gaps to management in a timely manner. • Communicate effectively across all audiences (verbal & written). • Develop and implement internal program processes ensuring CMS/HHS compliant programs, including contributing to Cigna IFP Coding Guideline updates and policy determinations, as needed. Education & Experience: The Quality Review & Audit Analyst will have a high school diploma and at least 2 years’ experience in one of the following Coding Certifications by either the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC): o Certified Professional Coder (CPC) o Certified Coding Specialist for Providers (CCS-P) o Certified Coding Specialist for Hospitals (CCS-H) o Registered Health Information Technician (RHIT) o Registered Health Information Administrator (RHIA) o Certified Risk Adjustment Coder (CRC) certification Individuals who have a certification other than the CRC must become CRC certified within 6 months of hire. Minimum Qualifications: • Experience with medical documentation audits and medical chart reviews and proficiency with ICD-10-CM coding guidelines and conventions • Familiarity with CMS regulations for Risk Adjustment programs and policies related to documentation and coding compliance, with both Inpatient and Outpatient documentation • HCC coding experience preferred • Computer competency with excel, MS Word, Adobe Acrobat • Must be detail oriented, self-motivated, and have excellent organization skills • Understanding of medical claims submissions is preferred • Ability to meet timeline, productivity, and accuracy standards If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an hourly rate of 25 - 38 USD / hourly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Perform evidence-based medical case reviews and physician consultations remotely to ensure appropriate patient care in pulmonology. | Requires MD or DO with active US medical license, board certification in Pulmonology, 3+ years clinical experience post residency, and strong computer skills. | The job profile for this position is Utilization Review Medical Principal, which is a Band 5 Senior Contributor Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply! Our people make all the difference in our success. Do you crave an intellectually stimulating job that allows you to leverage your clinical expertise while developing new skills and improving the lives of others? Then look no further! As a Pulmonology Medical Director at EviCore, part of Evernorth Health Services, a division of The Cigna Group, you’ll use your clinical know-how to provide evidence-based medical reviews for patient care. Collaborate with healthcare providers and stay current on healthcare regulations and industry developments as you review a wide range of cases. This role offers you the opportunity to build new skills while enhancing the health and vitality of others. We're seeking a detail-oriented individual with good communication, technology, and typing skills, as well as strong clinical judgment. Drive growth in your career with our innovative team. How you’ll make a difference: You’ll start training remotely in a structured environment with support from trainers, mentors, and leadership to set you up for success. Complete time-sensitive, specialized evidence-based medical case reviews for medical necessity on EviCore’s case management software. Conduct physician consultation (peer-to-peer) calls with referring providers to discuss evidence–based medical necessity and appropriateness of the requested service or treatment. Leverage your clinical expertise to recommend alternative services or treatments as necessary. Work collaboratively with over 500 EviCore physician colleagues to help ensure patients receive proper care via evidence-based decision making. What you’ll enjoy about working here: Benefits start on day one Predictable work schedules 100% work from home 8 Paid Holidays + 23 PTO Days 401(K) with company match Reimbursement for continuing medical education Career growth opportunities across the enterprise Networking with peers across multiple medical specialties Requirements: M.D. or D.O. with a current, active, U.S. state medical license and board certified in Pulmonology, recognized by the American Board of Medical Specialties, or American Osteopathic Association Eligible to acquire additional state licensure as required 3 years of relevant clinical experience post residency/fellowship Knowledge of applicable state federal laws Utilization Review Accreditation Commission and National Committee for Quality Assurance standards is a plus Ability to commit to a set, weekly work schedule (Monday through Friday) Strong computer skills: ability to work autonomously with automated processes, computer applications, and systems Meet physical demands of the role including, but not limited to, typing, speaking, and listening 100% of time In accordance with our HITECH Security Accreditation, company provided encrypted-workstation is required to be hard-wire connected to a modem or router. Wireless connection is not permitted. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 203,200 - 338,600 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Perform evidence-based medical reviews and peer-to-peer consultations on pediatric surgery cases remotely to ensure proper patient care. | Must have MD or DO with pediatric surgery board certification, active US medical license, 3 years clinical experience, and strong clinical and communication skills. | Do you crave an intellectually stimulating job that allows you to leverage your clinical expertise while developing new skills and improving the lives of others? Then look no further! As a Pediatric Surgery Medical Director at EviCore, part of Evernorth Health Services, a division of The Cigna Group, you’ll use your clinical know-how to provide evidence-based medical reviews for patient care. Collaborate with healthcare providers and stay current on healthcare regulations and industry developments as you review a wide range of cases. This role offers you the opportunity to build new skills while enhancing the health and vitality of others. We're seeking a detail-oriented individual with good communication, technology, and typing skills, as well as strong clinical judgment. Drive growth in your career with our innovative team. How you’ll make a difference: You’ll start training remotely in a structured environment with support from trainers, mentors, and leadership to set you up for success. Complete time-sensitive, specialized evidence-based medical case reviews for medical necessity on EviCore’s case management software. Conduct physician consultation (peer-to-peer) calls with referring providers to discuss evidence–based medical necessity and appropriateness of the requested service or treatment. Leverage your clinical expertise to recommend alternative services or treatments as necessary. Work collaboratively with over 500 EviCore physician colleagues to help ensure patients receive proper care via evidence-based decision making. What you’ll enjoy about working here: Benefits start on day one Predictable work schedules 100% work from home 8 Paid Holidays + 23 PTO Days 401(K) with company match Reimbursement for continuing medical education Career growth opportunities across the enterprise Networking with peers across multiple medical specialties Requirements: M.D. or D.O. with a current, active, U.S. state medical license and board certified in Pediatric Surgery recognized by the American Board of Medical Specialties, or American Osteopathic Association Eligible to acquire additional state licensure as required Prefer one of the following state medical licenses but is not required: DC, MD or VA 3 years of relevant clinical experience post residency/fellowship Knowledge of applicable state federal laws Utilization Review Accreditation Commission and National Committee for Quality Assurance standards is a plus Ability to commit to a set, weekly work schedule (Monday through Friday) Strong computer skills: ability to work autonomously with automated processes, computer applications, and systems Meet physical demands of the role including, but not limited to, typing, speaking, and listening 100% of time In accordance with our HITECH Security Accreditation, company provided encrypted-workstation is required to be hard-wire connected to a modem or router. Wireless connection is not permitted. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 203,200 - 338,600 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group. About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

The Clinical Policy Lead Analyst is responsible for creating and maintaining evidence-based clinical guidelines and policies through literature evaluation. They will also present revised guidelines to the Medical Advisory Committee and engage with internal and external stakeholders. | Candidates must have a degree in Nursing or a related healthcare field and at least 3 years of experience in medical writing or clinical research. Strong skills in literature evaluation and peer-reviewed publications are essential. | Clinical Policy Lead Analyst: Summary: Create and maintain technical assessments and evidence-based policy for clinical programs through evaluation of published literature. Serve as primary author of evidence-based for program-specific clinical guidelines Monitor peer-reviewed, published evidence-updates for relevant clinical programs Maintain evidence tables and apply evidence-grading to literature Apply evidence updates to clinical guidelines Maintain library of relevant literature Maintain policy library through regular assessments and updates and revise and maintain clinical guidelines in the content management system Present revised clinical guidelines to the Medical Advisory Committee (MAC) Present to external stakeholders as needed Work with internal stakeholders related to clinical guideline development, maintenance, and implementation Act as a subject matter expert for programs and guidelines assigned Partner with internal and external subject matter experts to assimilate current practice standards into clinical policy, reconciling with published literature Ensure downstream operational representation, such as branching logic, is consistent with the intent of the clinical policy as approved by MAC Provide thought leadership and subject matter expertise for complex projects, working across business units Engage in cross-enterprise projects through ICOG aimed at creating optimal health care experiences Minimum Qualifications: Degree in Nursing or Healthcare related field (e.g.: Public Health, Healthcare Administration) Minimum of 3 years of experience in medical writing, clinical or policy research, literature evaluation and peer-reviewed publications. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 74,400 - 124,000 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group. About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Conduct evidence-based medical reviews and peer-to-peer consultations for orthopedic spine surgery cases to ensure appropriate patient care. | MD or DO with active US medical license, board certification in orthopedic spine surgery, 3+ years clinical experience post residency/fellowship, strong computer skills, and ability to work remotely with secure internet connection. | Do you crave an intellectually stimulating job that allows you to leverage your clinical expertise while developing new skills and improving the lives of others? Then look no further! As an Orthopedic Spine Surgery Medical Director at EviCore, part of Evernorth Health Services, a division of The Cigna Group, you’ll use your clinical know-how to provide evidence-based medical reviews for patient care. Collaborate with healthcare providers and stay current on healthcare regulations and industry developments as you review a wide range of cases. This role offers you the opportunity to build new skills while enhancing the health and vitality of others. We're seeking a detail-oriented individual with good communication, technology, and typing skills, as well as strong clinical judgment. Drive growth in your career with our innovative team. How you’ll make a difference: You’ll start training remotely in a structured environment with support from trainers, mentors, and leadership to set you up for success. Complete time-sensitive, specialized evidence-based medical case reviews for medical necessity on EviCore’s case management software. Conduct physician consultation (peer-to-peer) calls with referring providers to discuss evidence–based medical necessity and appropriateness of the requested service or treatment. Leverage your clinical expertise to recommend alternative services or treatments as necessary. Work collaboratively with over 500 EviCore physician colleagues to help ensure patients receive proper care via evidence-based decision making. What you’ll enjoy about working here: Benefits start on day one Predictable work schedules 100% work from home 8 Paid Holidays + 23 PTO Days 401(K) with company match Reimbursement for continuing medical education Career growth opportunities across the enterprise Networking with peers across multiple medical specialties Requirements: M.D. or D.O. with a current, active, U.S. state medical license and board certified in Orthopedic Spine Surgery, recognized by the American Board of Medical Specialties, or American Osteopathic Association Eligible to acquire additional state licensure as required 3 years of relevant clinical experience post residency/fellowship Knowledge of applicable state federal laws Utilization Review Accreditation Commission and National Committee for Quality Assurance standards is a plus Ability to commit to a set, weekly work schedule (Monday through Friday) Strong computer skills: ability to work autonomously with automated processes, computer applications, and systems Meet physical demands of the role including, but not limited to, typing, speaking, and listening 100% of time In accordance with our HITECH Security Accreditation, company provided encrypted-workstation is required to be hard-wire connected to a modem or router. Wireless connection is not permitted. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 203,200 - 338,600 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group. About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Perform evidence-based medical case reviews and physician consultations remotely to ensure appropriate patient care in cardiovascular disease. | MD or DO with active US medical license, board certified in cardiovascular disease, 3+ years clinical experience post residency, strong computer skills, and ability to work remotely with secure internet. | Do you crave an intellectually stimulating job that allows you to leverage your clinical expertise while developing new skills and improving the lives of others? Then look no further! As a Cardiovascular Disease Medical Director at EviCore, part of Evernorth Health Services, a division of The Cigna Group, you’ll use your clinical know-how to provide evidence-based medical reviews for patient care. Collaborate with healthcare providers and stay current on healthcare regulations and industry developments as you review a wide range of cases. This role offers you the opportunity to build new skills while enhancing the health and vitality of others. We're seeking a detail-oriented individual with good communication, technology, and typing skills, as well as strong clinical judgment. Drive growth in your career with our innovative team. How you’ll make a difference: You’ll start training remotely in a structured environment with support from trainers, mentors, and leadership to set you up for success. Complete time-sensitive, specialized evidence-based medical case reviews for medical necessity on EviCore’s case management software. Conduct physician consultation (peer-to-peer) calls with referring providers to discuss evidence–based medical necessity and appropriateness of the requested service or treatment. Leverage your clinical expertise to recommend alternative services or treatments as necessary. Work collaboratively with over 500 EviCore physician colleagues to help ensure patients receive proper care via evidence-based decision making. What you’ll enjoy about working here: Benefits start on day one Predictable work schedules 100% work from home 8 Paid Holidays + 23 PTO Days 401(K) with company match Reimbursement for continuing medical education Career growth opportunities across the enterprise Networking with peers across multiple medical specialties Requirements: M.D. or D.O. with a current, active, U.S. state medical license and board certified in Cardiovascular Disease, recognized by the American Board of Medical Specialties, or American Osteopathic Association Eligible to acquire additional state licensure as required 3 years of relevant clinical experience post residency/fellowship Knowledge of applicable state federal laws Utilization Review Accreditation Commission and National Committee for Quality Assurance standards is a plus Ability to commit to a set, weekly work schedule (Monday through Friday) Strong computer skills: ability to work autonomously with automated processes, computer applications, and systems Meet physical demands of the role including, but not limited to, typing, speaking, and listening 100% of time In accordance with our HITECH Security Accreditation, company provided encrypted-workstation is required to be hard-wire connected to a modem or router. Wireless connection is not permitted. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 203,200 - 338,600 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group. About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Perform evidence-based medical case reviews and physician consultations remotely to ensure appropriate patient care in gastroenterology. | Must have MD or DO with active US medical license, board certification in gastroenterology, 3+ years clinical experience, and ability to work remotely with strong computer skills. | Do you crave an intellectually stimulating job that allows you to leverage your clinical expertise while developing new skills and improving the lives of others? Then look no further! As a Gastroenterology Medical Director at EviCore, part of Evernorth Health Services, a division of The Cigna Group, you’ll use your clinical know-how to provide evidence-based medical reviews for patient care. Collaborate with healthcare providers and stay current on healthcare regulations and industry developments as you review a wide range of cases. This role offers you the opportunity to build new skills while enhancing the health and vitality of others. We're seeking a detail-oriented individual with good communication, technology, and typing skills, as well as strong clinical judgment. Drive growth in your career with our innovative team. How you’ll make a difference: You’ll start training remotely in a structured environment with support from trainers, mentors, and leadership to set you up for success. Complete time-sensitive, specialized evidence-based medical case reviews for medical necessity on EviCore’s case management software. Conduct physician consultation (peer-to-peer) calls with referring providers to discuss evidence–based medical necessity and appropriateness of the requested service or treatment. Leverage your clinical expertise to recommend alternative services or treatments as necessary. Work collaboratively with over 500 EviCore physician colleagues to help ensure patients receive proper care via evidence-based decision making. What you’ll enjoy about working here: Benefits start on day one Predictable work schedules 100% work from home 8 Paid Holidays + 23 PTO Days 401(K) with company match Reimbursement for continuing medical education Career growth opportunities across the enterprise Networking with peers across multiple medical specialties Requirements: M.D. or D.O. with a current, active, U.S. state medical license and board certified in Gastroenterology, recognized by the American Board of Medical Specialties, or American Osteopathic Association Eligible to acquire additional state licensure as required 3 years of relevant clinical experience post residency/fellowship Knowledge of applicable state federal laws Utilization Review Accreditation Commission and National Committee for Quality Assurance standards is a plus Ability to commit to a set, weekly work schedule (Monday through Friday) Strong computer skills: ability to work autonomously with automated processes, computer applications, and systems Meet physical demands of the role including, but not limited to, typing, speaking, and listening 100% of time In accordance with our HITECH Security Accreditation, company provided encrypted-workstation is required to be hard-wire connected to a modem or router. Wireless connection is not permitted. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 203,200 - 338,600 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group. About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

The role involves overseeing daily operations for IFP Risk Adjustment Data Validation audits and supporting Supplemental Diagnosis programs. The analyst will also communicate productivity and risks associated with audits and collaborate with internal teams for compliance and program excellence. | Candidates must have a high school diploma and at least 5 years of Risk Adjustment experience, with relevant certifications. Proficiency in ICD-10-CM coding and familiarity with CMS regulations are also required. | The job profile for this position is Quality Review and Audit Senior Analyst, which is a Band 3 Senior Contributor Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply! Our people make all the difference in our success. Job Summary: Responsible for coordination and implementation of daily processes related to IFP Risk Adjustment (RA) programs, including the Risk Adjustment Data Validation (RADV) audit and the Supplement Diagnosis program. Responsible for liaising with the Initial Validation Audit Entity to ensure compliant, efficient, and successful audit processes, including but not limited to file reconciliation and appeals processes. Responsible for coordinating with Quality Mgmt to effectively and compliantly execute daily RA program operations, as identified. Participates in coding reviews of medical documentation for RA programs, as needed. Responsible for communication and reporting of daily productivity and risks associated with IFP RADV audits and other RA programs, as needed, and collaborates with internal educational team to develop necessary curriculum to ensure compliance and program excellence. Contributes to Cigna IFP Coding Guideline updates and policy determinations, and liaises with Matrix Partners, as required, to develop and promote shared goals. The Quality Review and Audit Senior Analyst position recognizes experience in Risk Adjustment Data Validation audits (RADV), Risk Adjustment operations, Risk Adjustment medical record and diagnosis coding excellence, implementation of Quality Improvement processes, and the ability to communicate experience and knowledge to peers, colleagues, and Matrix Partners. Core Responsibilities: Oversight and coordination of daily operations for IFP Risk Adjustment Data Validation (RADV) audits, Support of Supplemental Diagnosis programs, as required Demonstrates comprehensive understanding and proficiency with the Complete Official Code Set, Coding Clinic, and CMS guidelines for IFP code abstraction and medical record compliance Demonstrates comprehensive understanding of RADV Protocols and Compliance Requirements for RA programs, including EDGE Server Business Rules, where applicable Demonstrates ability to coordinate with external partners to execute efficient and compliant programs Demonstrates ability to identify risks or program gaps and communicate effectively to management in a timely manner Demonstrates ability to report productivity, progress, and risks to leadership on a timely basis Develops and implements internal program processes, as required Coordinates with Quality Mgmt to determine priorities and demonstrates ability to prioritize projects to meet deadlines, as determined Demonstrates the ability to remain current on Federal regulations related to diagnosis coding and the HHS Risk Adjustment program, including audit protocols Demonstrates effective communication skills with peers and matrix partners to ensure Continuous Quality Improvement and ensure compliance with all CMS guidelines and regulations Engages in Continuous Quality Improvement (CQI) of IFP programs, as applicable Demonstrates ability to work with external auditors to ensure compliant, efficient, and successful risk adjustment audits, per CMS standards Demonstrates medium proficiency with Microsoft Outlook, Microsoft Excel, Microsoft Word Demonstrates clear and concise professional communication with peers and supervisors, in verbal, telephonic, and written communication Demonstrates knowledge of HIPAA guidelines and protection of PHI in physical and electronic environments Demonstrates the ability to follow verbal and written directions accurately and timely Demonstrates the ability to follow applicable policies and procedures Ability to work independently to accomplish assigned work within the allocated time, meeting deadlines as appropriate Demonstrates ability and willingness to assume other duties as requested, which may or have not be listed in the job description Minimum Qualifications: High School Diploma 5+ year’s Risk Adjustment experience, with certification by either the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC) in one of the following certifications: Certified Professional Coder (CPC) Certified Coding Specialist for Providers (CCS-P) Certified Coding Specialist for Hospitals (CCS-H) Registered Health Information Technician (RHIT) Registered Health Information Administrator (RHIA) Certified Risk Adjustment Coder (CRC) certification (within 12 months of hire) Experience with medical audits Proficiency with ICD-10-CM coding and guidelines Familiarity with CMS regulations and polices related to documentation and coding, both with Inpatient and Outpatient documentation HCC coding experience preferred Computer competency with excel, MS Word, Adobe Acrobat Must be detail oriented, self-motivated, and have excellent organization skills Risk Adjustment/CMS knowledge helpful Understanding of medical claims submissions, helpful If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 58,400 - 97,400 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Perform evidence-based medical case reviews and physician consultations for pediatric cardiology utilization management in a fully remote setting. | Requires MD or DO with active US medical license, board certification in pediatric cardiology, 3+ years clinical experience post residency/fellowship, knowledge of healthcare laws, and strong computer skills. | The job profile for this position is Utilization Review Medical Principal, which is a Band 5 Senior Contributor Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply! Our people make all the difference in our success. Do you crave an intellectually stimulating job that allows you to leverage your clinical expertise while developing new skills and improving the lives of others? Then look no further! As a Pediatric Cardiology Medical Director at EviCore, part of Evernorth Health Services, a division of The Cigna Group, you’ll use your clinical know-how to provide evidence-based medical reviews for patient care. Collaborate with healthcare providers and stay current on healthcare regulations and industry developments as you review a wide range of cases. This role offers you the opportunity to build new skills while enhancing the health and vitality of others. We're seeking a detail-oriented individual with good communication, technology, and typing skills, as well as strong clinical judgment. Drive growth in your career with our innovative team. How you’ll make a difference: You’ll start training remotely in a structured environment with support from trainers, mentors, and leadership to set you up for success. Complete time-sensitive, specialized evidence-based medical case reviews for medical necessity on EviCore’s case management software. Conduct physician consultation (peer-to-peer) calls with referring providers to discuss evidence–based medical necessity and appropriateness of the requested service or treatment. Leverage your clinical expertise to recommend alternative services or treatments as necessary. Work collaboratively with over 500 EviCore physician colleagues to help ensure patients receive proper care via evidence-based decision making. What you’ll enjoy about working here: Benefits start on day one Predictable work schedules 100% work from home 8 Paid Holidays + 23 PTO Days 401(K) with company match Reimbursement for continuing medical education Career growth opportunities across the enterprise Networking with peers across multiple medical specialties Requirements: M.D. or D.O. with a current, active, U.S. state medical license and board certified in Pediatric Cardiology, recognized by the American Board of Medical Specialties, or American Osteopathic Association Eligible to acquire additional state licensure as required Prefer one of the following state medical licenses but is not required: DC, MD or VA 3 years of relevant clinical experience post residency/fellowship Knowledge of applicable state federal laws Utilization Review Accreditation Commission and National Committee for Quality Assurance standards is a plus Ability to commit to a set, weekly work schedule (Monday through Friday) Strong computer skills: ability to work autonomously with automated processes, computer applications, and systems Meet physical demands of the role including, but not limited to, typing, speaking, and listening 100% of time In accordance with our HITECH Security Accreditation, company provided encrypted-workstation is required to be hard-wire connected to a modem or router. Wireless connection is not permitted. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 203,200 - 338,600 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.