Executive Medical Director, DME/IRF

The Cigna Group

Medical Director overseeing EviCore’s DME and IRF utilization management programs. Leading clinical guidelines, physician supervision, audits, appeals, and medical necessity reviews.

Posted 8/22/2026full-timeRemote • 🇺🇸 United StatesLead💰 $238,100 - $396,800 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Durable Medical Equipment and Inpatient Rehabilitation Facility management, with a strong focus on clinical guideline development, utilization management, and compliance with state and federal regulations. Proven ability to lead and mentor medical directors while ensuring adherence to clinical policies and procedures.

Highest-signal resume keywords

M.D. Or D.O. DegreeActive Board Certification In Physical Medicine & RehabilitationUtilization Management ExperienceSupervisory ExperienceManaged Care Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical Guideline DevelopmentDME Policy ManagementMedical Necessity ReviewsCase AuditingClinical Pathway Development

Soft Skills

CoachingMentoringCommunicationCollaborationLeadership

Tools & Technologies

Automated ProcessesComputer ApplicationsInternet Connection

Certifications & Qualifications

Active Unrestricted Medical LicenseBoard Certification In Physical Medicine & Rehabilitation

Industry Keywords

Utilization ReviewURAC StandardsNCQA StandardsMedicareMedicaid

About the role

Key responsibilities & impact

Oversee intraday activities of EviCore’s Durable Medical Equipment and Inpatient Rehabilitation Facility management programs and services
Serve as program internal lead for DME clinical guideline and policy management
Work with the Guideline Manager to create EviCore DME guidelines
Maintain and update DME denial rationales
Represent EviCore in Medicare or Medicaid DME and IRF audits and case discussions
Support development of DME clinical pathways with the pathways team
Create quarterly DME IRR quizzes and hold physician debriefs
Assist in case audits assessing Associate Medical Directors’ and Medical Directors’ decision-making accuracy and adherence to EviCore criteria and processes
Hold regular 1:1 meetings with DME/IRF Associate Medical Directors and Medical Directors
Provide weekend coverage for urgent DME and IRF appeals
Testify at ALJ hearings when cases are appealed or the adjudicating Associate Medical Director is unavailable
Provide audit support for DME and IRF cases reviewed during CMS and client audits
Assist with interviewing, onboarding, and training new DME/IRF Associate Medical Directors
Serve as subject matter expert and first point of contact for problematic or escalated case reviews
Respond to urgent, expedited, or escalated DME and IRF cases and P2Ps
Review client case determinations related to provider or member complaints
Respond to notifications and requests to amend incorrect reviews when the original physician reviewer is unavailable
Manage day-to-day clinical activities of the EviCore DME/IRF Program
Collaborate with Clinical Operations, Non-clinical Operations, and Program Operations leadership to optimize program functioning
Supervise and manage DME/IRF Medical Directors and Associate Medical Directors
Support development and maintenance of EviCore policies, procedures, and clinical certification criteria
Coordinate clinical development and education through educational materials and quarterly sessions
Evaluate Medical Directors’ and Associate Medical Directors’ performance
Coach, mentor, and/or clinically supervise designated Medical Directors and Associate Medical Directors
Support review of EviCore clinical guidelines
Support sales and client management teams as clinical representative when requested
Provide expert medical necessity reviews and clinical opinions, including post-decision reviews
Maintain necessary credentials and report adverse actions involving medical licenses or board certifications
Communicate EviCore policies and procedures to the provider community
Participate in required educational and quality improvement activities and maintain passing assessment scores
Perform other duties as assigned

Requirements

What you’ll need

M.D. or D.O. degree from accredited institution
Minimum of five (5) years of clinical practice experience after completion of all graduate medical education training, including residency and fellowship (when applicable)
Active board certification in Physical Medicine & Rehabilitation
Active unrestricted license to practice medicine in a state or territory of the United States as a utilization review doctor of medicine or doctor of osteopathic medicine
Knowledge of applicable state and federal laws, URAC and NCQA standards, and utilization management
Two (2) or more years of managed care experience
Familiarity with automated processes and computer applications and systems
Supervisory and/or management experience strongly preferred
Internet connection through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload when working at home

Benefits

Comp & perks

Annual bonus eligibility
Long term incentive plan eligibility
Medical benefits
Vision benefits
Dental benefits
Well-being and behavioral health programs
401(k)
Company-paid life insurance
Tuition reimbursement
Minimum of 18 days of paid time off per year
Paid holidays
Leaves of absence
Remote work arrangement
Cable broadband or fiber optic internet service with at least 10Mbps download/5Mbps upload for home working