Medical Director - Oncology Specialist Position Overview: This role focuses on providing regional and national medical review and case management for Cigna Healthcare. The Medical Director will deliver clinical insights to enhance internal and external customer services while acting as a pivotal educator and consultant to various operational areas. Key Responsibilities: Conduct benefit-driven medical necessity reviews using federal/state regulations, clinical guidelines, and best practices. Focus on achieving quality outcomes for our customers while balancing service and cost. Enhance clinical outcomes through effective communication, education, and negotiation with healthcare professionals. Act as an advocate for customers/members while incorporating business needs into decision-making. Engage in all Appeal processes as permitted by regulatory agencies. Contribute to developing and maintaining coverage guidelines and medical management initiatives. Participate in quality assurance processes, including audits and clinical reviews. Mentor other Medical Directors and colleagues in quality improvement efforts. Foster positive relationships with healthcare professionals through direct communication and evidence-based information. Regularly update knowledge through continued education and compliance testing. Address customer service issues with guidance and support from leadership. Respond to client and regulatory inquiries, assisting in problem resolution. Meet internal and regulatory compliance goals through timely and quality reviews. Provide clinical insights and support functions as needed. Minimum Requirements: Unrestricted medical license in a US state or territory. Board certification in a recognized specialty. At least 5 years of clinical practice experience beyond residency. Proficient in Microsoft Office Suite applications. Not excluded from any federal healthcare program. Not listed in CMS' Preclusion List. Preferred Qualifications: Experience in medical management and utilization review. Knowledge of managed care products and their strategies. Ability to adapt in a changing business environment while balancing patient advocacy and business needs. Experience in fast-paced project management. Strong abilities in teamwork, negotiation, conflict management, and problem-solving. Competency in understanding complex issues to implement effective solutions. Sensitivity to culturally diverse situations and clients. Fluency in Spanish or other languages is a plus. For home-based work, a wired internet connection with at least 10Mbps download/5Mbps upload speed is required. The anticipated annual salary ranges from 206,300 to 343,900 USD, based on experience and location, with additional eligibility for bonuses and long-term incentives. We offer comprehensive health benefits starting day one, including medical, vision, dental, and wellness programs, a 401(k) plan with company match, company-paid life insurance, tuition reimbursement, and a minimum of 18 days of paid time off each year. About Cigna Group: Join us in our mission to enhance lives through improved health and well-being. We are committed to making a difference for our clients, customers, and patients. All qualified applicants will be considered for employment without regard to race, color, age, disability, sex, or other protected characteristics. We provide reasonable accommodations for applicants with disabilities in the application process. Cigna Group has a tobacco-free policy and may not hire tobacco/nicotine users in certain states unless they participate in a cessation program prior to employment.