Medical Principal - Gastroenterologist

TheCignaGroup LLC

United States
Base: 212,600 - 354,300 usd / yearly; bonus/equity...
On-site
Clinical insight and consultation
Peer review and benefit review
Medical necessity reviews
The Cigna Group is seeking a Medical Principal - Gastroenterologist to perform medical reviews and case management activities, providing clinical insights across various departments. This position requires a current medical license, board certification in Gastroenterology, and at least five years of clinical practice experience

Job Summary

  • Performs benefit-driven medical necessity reviews for coverage, case management, and claims resolution, using benefit plan information, applicable federal and state regulations, clinical guidelines, and best practice principles.
  • Improves clinical outcomes through daily interactions with health care professionals using active listening, education, and excellent communication and negotiation skills.
  • Achieves internal customer satisfaction and regulatory/accreditation agency compliance goals by assuring both timely turn-around of coverage reviews and quality outcomes based on those review decisions.

Matching Summary

Match Score: 85

The Cigna Group is seeking a Medical Principal - Gastroenterologist to perform medical reviews and case management activities, providing clinical insights across various departments. This position requires a current medical license, board certification in Gastroenterology, and at least five years of clinical practice experience.

Salary

Base: 212,600 - 354,300 USD / yearly; Bonus/Equity: Annual bonus and long term incentive plan; Benefits: Medical, vision, dental, well-being programs, 401(k), life insurance, tuition reimbursement, 18+ PTO days, paid holidays

Skills & Requirements

Must-have

  • Clinical insight and consultation
  • Peer review and benefit review
  • Medical necessity reviews
  • Quality outcomes for members
  • Evidence-based clinical information

Nice-to-have

  • Managed care experience
  • Strong negotiation skills
  • Cultural sensitivity
  • Fluency in Spanish

Key Requirements

  • Current unrestricted medical license
  • Board certification in Gastroenterology
  • Minimum of 5 years clinical practice experience
  • Computer competency

Work Rights

Not specified

Tailored Resume

Cover Letter