Evernorth Direct Health(ENDH) offers health care delivery services and health and wellness coaching programs at or near an employer's work site with services that include advanced primary care practices, custom coaching, wellness event services and return to work programs. We are a national business that offers innovative models of care for advanced primary care services in person and virtually. Our mission is to deliver proactive, personalized and holistic patient care by acting on health data and insights to improve the overall health and wellness of our clients' employees, and those they care about most, by providing access to high quality, affordable services where they work and live.
As part of the Evernorth Direct Health leadership team, the Senior Medical Director will drive the clinical strategy, development guidance for our clinical programs and our clinical quality programs to advance innovative strategies of care and better health outcomes that will facilitate a shift to value based reimbursement. The Senior Medical Director will also help drive the population health programs and care team approach that will continue to drive enhanced utilization of our services and improve the overall total population health of the clients and customers we serve.
This position is with Evernorth, a new business within the Cigna Corporation.
Duties and Responsibilities:
Strategic Development and Business Growth:
Leadership of the clinical strategy for current and emerging care models, driving competitive, innovative care services that will align with the needs of clients and prospects to fully support the business growth strategies and performance plan.
Leadership for the national Direct Health Practices, with ongoing assessment of clinical models and overall performance of the clinical staff, consulting and coaching the staff, in partnership with Operations Directors and Clinical program Operations team, when quality issues arise or new models of care are launched.
Leadership of clinical strategy to grow and evolve client-specific care delivery and care services models to achieve client ROI and total population level health outcomes, creating multi-year strategies in partnership with the Operations Directors.
Leadership of the evolution of clinical care models to facilitate shift to value based reimbursement and population health programs.
Collaboration and shared leadership of integrated care models with other enterprise benefit services within client benefit structure to maximize care team models, integrated connected care and better health outcomes.
Partner with our Sales team to provide clinical support in client and/or prospective client meetings.
Assistance in the development of RFP responses, pre-sales opportunities and review of Cigna client metrics.
Quality of Care and Compliance:
Leadership and accountability for the business' Care Quality Programs, working with cross functional owners across the enterprise to support the quality program requirements for metrics and monitoring, and driving new program needs to achieve industry-leading quality standards and accreditation programs.
Leadership of the creation and implementation of medical policies for Evernorth Direct Health consistent with evidence-based medicine.
Collaboration with multi-disciplinary team to establish clinical and operational processes and protocols for clinics and coaches to drive improved clinical outcomes, including peer review process and prevention of malpractice or other legal/compliance medical issues.
Collaboration with Legal and Compliance to align the practice of care with local, state and federal regulations across in person and virtual care services.
Establishes and implements policies and standards, evaluates new treatments, and evaluates available data sources to ensure the quality of the medical care provided to customers at Evernorth Direct Health centers and Health Coach sites.
Assists in development and implementation of strategic clinical goals related to quality improvement and accreditation standards
Revise and enhance existing medical care standards, protocols and practices when indicated.
In conjunction with Quality and Operations, create benchmarks (e.g., HEDIS) to ensure that patients are receiving the highest quality of care.
Assists in the development and maintenance of statistical data related to patient care and patient outcomes.
Oversees regular chart reviews and audits as part of ongoing Quality Assurance.
Assists in improving EMR usability and clinician satisfaction
Work cooperatively with plan quality personnel on any quality of care concerns or projects.
Assists in developing quality improvement projects.
Establish and Chair Clinical Peer Review Committee.
Clinical oversight of vaccine programs.
Ensure that standards for emergency equipment, supplies and medications at all ENDH sites are met.
Collaborate with Quality and Operations team to ensure infection control and emergency response policies are appropriate and up-to-date.
Clinical Informatics and Clinical Model Support:
Leadership and accountability to develop and maintain industry leading clinical metrics and analysis and design input for clinical informatics reporting for analysis of programs, health outcomes, and utilization.
Leadership and strategic input for Epic Electronic Health Record and clinical input required to build and support enhancements.
Participate on the Epic Executive Leadership Steering Committee.
Responsible to ensure that ENDH providers are following appropriate standards of care and engaged in Evernorth Direct Health.
Provide education and development to the ENDH provider community Physician Management/Engagement.
Responsible to ensure that ENDH physicians are following appropriate standards of care and assist in their engagement in Evernorth Direct Health.
Provide support and mentoring to ENDH physicians, nurse practitioners, and physician assistants.
Strategic Development: Expected to be a key contributor to the ongoing strategic development of Evernorth Direct Health products and services.
Coordinate approval of MD/Physician Extender CME Requests.
Actively participate in Physician/Physician Extender Recruiting.
Support collaborative physician contracting and assist in maintenance of collaborative physician relationships.
Degree in medicine from an accredited school and is licensed to practice medicine (Doctor of Medicine or Doctor of Osteopathic Medicine); Internal Medicine, or Family Medicine strongly preferred.
Current unrestricted medical license in a US state or territory.
Current board certification (lifetime certification or certification maintained by MOC or other applicable program) in an ABMS or AOA recognized specialty.
Exhibits ethical and professional behavior.
Minimum of 5 years of clinical practice experience and/or direct patient care beyond residency.
Collaborative partner with drive for new and innovative clinically sound approaches to care.
Ability to be hands on, adaptable, focused, flexible, data driven, results-oriented, and a high performer.
Good communication skills and project management skills.
Able to organize, prepare, and deliver presentations to groups or in one-on-one settings.
Experience with a highly matrixed organization.
Clinical quality experience with previous accreditation experience preferred.
Proven analytical skills.
At least two years of clinical experience in a managed care organization are preferred.
Experience with and a sound understanding of:
Virtual Health models for primary care factoring in quality, safety and compliance.
Occupational Medicine including but not limited to pre-employment screenings, DOT physicals, and initial workplace injury management.
Physical Therapy integration with Primary Care and Occupational Medical practices.
Behavioral Health support and collaboration with Primary Care.
Experience with multi-disciplinary Care Team models.
Population Health programs including HEDIS measures and PCMH certification.
Experience with the Epic EMR system highly desired.
Computer Competency: Email, PowerPoint, Excel and Personal Information Management programs are used extensively.
This position is not eligible to be performed in Colorado.
Evernorth, Cigna Corporation's health services segment, exists to elevate health for all. We're building on our legacy and redefining health care as we know it. Unbiased in how we think, we create without limitation. We partner without constraints, deliver value differently and act in the interest of humanity. Solving across silos, closing gaps in care, and empowering clients, customers, and people everywhere to move onward and upward. When you work with us, you'll be empowered to solve the problems others don't, won't or can't. Join us. What difference will you make?
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.