Medical Advisor

JOB PURPOSE

The Medical Advisor will provide functional expertise on cases ensuring that
medical decisions adhere to Cigna’s global clinical guidelines. He/she will
manage pre-authorization services to ensure cost-effectiveness and
appropriateness of treatment, with the goals of generating cost savings and
improving health outcomes. The Medical Advisor will partner with other
business divisions such as Sales and Client Management, by applying medical
knowledge to support the business needs.

RESPONSIBILITIES AND DUTIES

Part of a clinical team that provides medical management services to customers
in KSA.

Handles most complex cases with full autonomy for decision making while
identifying and resolving barriers that hinder effective patient care.
Recognized internally as “the go-to person” for the most complex Health
Services assignments and as a “Subject Matter Expert”.

Provides strategic planning, and direction of a quality, cost effective
delivery system providing health services to members.

Studies trends and develops processes and procedures to ensure quality
service.

Establishes process and procedures to ensure quality programs will meet or
exceed guidelines or requirements by specific assigned vendors.
Responsibilities include, but are not limited to: analyzing and appraising
management as to performance of vendor services using measurement criteria;
collecting and analyzing data, identifying variance and unacceptable
performance, and monitoring correction and ongoing compliance; providing
resources and expertise in the areas of regulatory mandates, accreditation
standards, and implementing quality management process policies and
procedures; and managing individual case review and investigation.

Serves as a resource/educator regarding specific areas of expertise.

Uses deep professional knowledge and acumen to advise functional leaders on
development of wellness programs for internal and external stakeholders.

Serves as clinical advisor to the sales, client management, broker management
and underwriters, by providing ongoing product and industry
knowledge/education that positively influence cost, quality and customer
satisfaction.

Represents company externally as a clinical subject matter expert while
supporting sales and client management functions including attending client
meetings and participating in thought leadership events.

Maintains updated knowledge of local and regional regulatory insurance
mandates and clinical policies, and responsible for relaying this information
to the team and relevant stakeholders.

Assist in payment integrity by detection of fraud, waste or abuse in medical
review process, with clinical advice where required.

Manages inpatient and outpatient medical costs at levels consistent with the
plan's objectives by directing the case management, medical review,
utilization review, quality assurance/improvement, and/or health education
programs.

Focuses on implementing and executing strategies within own team.

Manages the development of processes and procedures to ensure the quality of
the medical review process and responsible for the performance, productivity,
and quality of the clinical team.

Other duties as assigned

Minimum requirements:
Medical Doctor Degree with international healthcare experience specially in
KSA and Middle East region.

‎5+ years of clinical experience preferable in a payer setting on medical
management.

‎2-‎3 years of managerial and leadership experience.

Experience in utilization/case management, cost containment services, managed
care, insurance coverage, and financial management.

Strong interpersonal and communication skills.

Demonstrates pro-active problem-solving and analytical skills.

Ability to operate a personal computer, proficient with Microsoft office
products and a variety of software for medical management.

Ability to build solid working relationships with staff, matrix partners,
clients, customers and healthcare providers.

Stress resistant and efficient, finding a good balance between quality and
quantity.

Language requirements:
English: read, write and speak fluently.

Arabic is a plus.

About The Cigna Group
Doing something meaningful starts with a simple decision, a commitment to
changing lives. At The Cigna Group, we’re dedicated to improving the health
and vitality of those we serve. Through our divisions Cigna Healthcare and
Evernorth Health Services, we are committed to enhancing the lives of our
clients, customers and patients. Join us in driving growth and improving
lives.

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: [email protected] for support. Do not email
[email protected] for an update on your application or to provide your
resume as you will not receive a response.