Medical Director (Inpatient Utilization and Population Management)

Location: United States Work at Home; occasional travel to attend in-person meetings may be required.

Salary: $230,600–$384,400 USD annually, depending on experience and geographic location. Eligible for an annual bonus and long-term incentive plan.

Company

hirify.global provides health care and health services through Cigna Healthcare and Evernorth Health Services, with a focus on improving client, customer, and patient health outcomes.

What you will do

• Lead clinicians delivering utilization management functions and strategic clinical initiatives.
• Perform medical necessity reviews for coverage, case management, and claims resolution using benefit plans, regulations, clinical guidelines, and best practices.
• Direct medical management functions for market, regional, or national programs, including utilization review, quality assurance, case management, medical policy, and new technology evaluation.
• Develop and implement clinical and medical management strategies while supporting network operations and serving as a physician liaison.
• Improve clinical outcomes and health care professional relationships through education, communication, negotiation, and evidence-based guidance.
• Mentor Medical Directors and colleagues, respond to client and regulatory questions, and support appeals, quality committees, and accreditation compliance.

Requirements

• Current unrestricted medical license in a US state or territory.
• Current board certification in an ABMS- or AOA-recognized specialty.
• At least five years of clinical practice or direct patient care experience beyond residency.
• Strong ethical and professional conduct, communication, negotiation, decision-making, conflict management, and problem-solving skills.
• Computer competency with word processing, spreadsheets, email, personal information management, and online clinical research.
• Cable broadband or fiber internet with at least 10 Mbps download and 5 Mbps upload is required for home work.

Nice to have

• At least three years of medical management, utilization review, or case management experience in a managed care setting.
• Knowledge of pharmacy claims, specialty pharmaceuticals, managed care products, and strategies.
• Experience managing physicians, nurses, or employees and working across multiple projects in a matrix environment.
• Experience with change management, stakeholder relations, education, service marketing, sales, or business acumen.

Culture & Benefits

• Full-time employment with health, vision, dental, well-being, and behavioral health benefits from the first day.
• 401(k), company-paid life insurance, tuition reimbursement, paid holidays, and leaves of absence.
• At least 18 days of paid time off per year.
• Work-from-home arrangement with specified broadband requirements and occasional in-person meetings.