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Medical consultant. Cigna Life insurance Company of Europe - 13/07/2017
Cigna Life insurance Company of Europe
The medical consultant is a member of the medical team, which develops and manages health and wellness programs for Cigna customers. Together with a team of nurses and physicians she/he will ensure attainment of quality, production, timeliness, cost containment goals, and excellent customer satisfaction for both internal and external customers.
Ability to review, investigate, and respond to external and internal inquires/complaints. Provides guidance and acts as a mentor or coach for the nurses and other non-clinical staff.
He/she works with a multicultural population and is constantly aware of the cultural differences among that population and the geographical regions.
Major responsibilities and desired results:
- Part of a clinical team that provides medical management services to customers worldwide.
- Give evidence-based advice on medical claims, taking into account internationally accepted protocols and local and/or regional customs and regulations.
- Support and monitor the case management, disease management and other clinical services and assure quality of performance against QA standards to promote optimal service delivery and ensure accurate statistical data and reports. Give advice on appropriate corrective action if necessary.
- Assist in fraud detection.
- Assist in the coordination of processes for improving quality of care and health outcomes for specifically delineated projects or populations. Excellent communication and facilitation skills are keys to success.
- Assist and support the team in cost containment, assist in projects and service delivery to meet goals.
- Work together with the team on quality improvement and clinical management projects within Clinical Operations.
- Serves as a resource/educator regarding specific areas of expertise. Able to create and implement appropriate educational clinical programs content for internal and external audiences and link with Cigna University resources.
- Other duties as assigned.
- Medical Doctor Degree with international healthcare experience.
- 3-5 years of clinical experience preferable in a payer setting on medical management.
- Experience in utilization management, case management, and disease management programs and tools is an advantage.
- Strong interpersonal and communication skills.
- Demonstrates pro-active problem-solving and analytical skills.
- Knowledge of utilization/case management, cost containment services, managed care, insurance coverage, and financial management.
- Ability to operate a personal computer, proficient with Microsoft office products, call center software, 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.
- Ability to speak, write and read English and Spanish, any other language a plus.
Persona de contacto: Carlos Vicente
Teléfono: 91 418 4579