Medical Director - Post-Acute Care - Evicore - Remote

OverviewMedical Director - Post-Acute Care - Evicore - Remote at Evernorth Health Services.ResponsibilitiesProvide 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.Engage in peer-to-peer discussions with treating physicians to clarify clinical information and explain review outcomes.Participate in proactive peer-to-peer collaboration to assist with 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 work teams, focusing on discharge planning, complex medical care management, quality of care, appropriate level of care, and 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 and communicate policies to the provider community.Testify at ALJ hearings when cases are appealed and assist with staff educational training and in-service programs as a clinical resource.Serve as a Subject Matter Expert when Medical Directors and Senior Medical Directors are unavailable.Be available for scheduled weekend call from home based on business needs.Participate in Joint Operating Committee (JOC) meetings and other virtual events with the provider engagement team in your territory.Participate in required educational and quality improvement activities and maintain passing scores in all assessments.Assist in reviewing case determinations from clients responding to provider or member complaints.Other duties as assigned.Minimum Education, Licensure and Professional CertificationMD or DO with active board certification in primary care specialties (Family Medicine, Internal Medicine or Emergency Medicine) OR board certification in Physical Medicine and Rehabilitation (American Board of Medical Specialties or American Osteopathic Association).Three or more years of relevant clinical practice post residency/fellowship.Active unrestricted license to practice medicine in a U.S. state or territory as a using 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 and ability to work autonomously with automated processes and systems.Physical capability to perform required tasks (typing, speaking, listening).In accordance with HITECH Security Accreditation, company-provided encrypted workstation must be hard-wired to a modem/router; wireless is not permitted.Additional InformationIf working from home, internet should be cable broadband or fiber with speeds at least 10 Mbps down/5 Mbps up.Salary range: 203,200 – 338,600 USD per year, depending on experience and location.Eligible for annual bonus plan.Benefits include medical, vision, dental, well-being and behavioral health programs; 401(k) with company match; company-paid life insurance; tuition reimbursement; at least 18 days of paid time off per year and paid prehensive employee benefits information is available via Life at Evernorth Health Services.About Evernorth Health ServicesEvernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and vitality. We innovate to make prediction, prevention and treatment more accessible. Join us in driving growth and improving lives.Equal Employment OpportunityQualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including 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 EEO laws.NotesIf you require reasonable accommodation in completing the online application process, please email for support. The Cigna Group has a tobacco-free policy where permitted by law. Qualified applicants with criminal histories will be considered in accordance with laws and regulations. #J-18808-Ljbffr

Created: 2025-10-06