Summary:
Lead and develop extremely talented and cross functional team responsible for day-to-day Maximum Allowable Cost (MAC) and pharmacy appeal regulations. Responsible for leading team that oversees State and Federal pharmacy reimbursement legislation and pharmacy appeals. Oversee business regulatory compliance projects and process enhancements. Monitor pharmacy reimbursement compliance solve complex problems and propose solutions. Support new legislation and serve as a subject matter expert (SME) pertaining to State and Federal pricing client specialty pricing and pharmacy appeals. Responsible for providing Ad Hoc training support and financial analysis of impacted areas for a variety of audiences and departments.
Responsibilities:
Qualifications:
About Evernorth Health Services
Evernorth Health Services a division of The Cigna Group creates pharmacy care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction prevention and treatment of illness and disease more accessible to millions of people. 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: for support. Do not email for an update on your application or to provide your resume as you will not receive a response.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama Alaska Arizona Arkansas Delaware Florida Georgia Hawaii Idaho Iowa Kansas Maryland Massachusetts Michigan Nebraska Ohio Pennsylvania Texas Utah Vermont and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal state and local ordinances.
Required Experience:
Senior Manager
Cigna Healthcare offers health insurance plans such as medical and dental to individuals and employers, international health insurance, and Medicare coverage.