Clinical Program Advisor Express Scripts Hybrid (Strategic Markets Prime)

This is a Hybrid position (3 days per week in-office 2 days work at home). The incumbent candidate can be based out of any US Cigna Healthcare office and is not restricted to locations that are listed in this posting.

JOB DESCRIPTION

The Clinical Program Advisor will be responsible for review consultation and clinical evaluation of utilization management criteria to align with pharmaceutical rebate contract requirements and providing quality assurance evaluations that will promote accurate rebate invoicing. This role will work cross-functionally with the Pharmaceutical Contracting Clinical Consulting and Pharmaceutical Invoicing teams to ensure formulary tier and clinical rules are interpreted correctly and will evaluate benefit set up impacts on rebated drug products. Reporting to the Clinical Program Director this position provides clinical support in documenting formulary placement/positioning and utilization management policies and procedures for the analysis and appropriate determination of client eligibility for rebate enhancement and exclusion options. Additionally this role offers consultative clinical support in the interpretation of rebate requirements contained within manufacturer rebate agreements as well as advice regarding impact assessments following any proposed or implemented changes to formulary tiers contracts or management policies. Additional responsibilities include acting as a point of contact for clients clinical and formulary-related initiatives completing financial/rebate impact assessments to evaluate utilization management strategies conducting ongoing formulary maintenance and new formulary implementation reviews and identifying prospects for clinical program adoption.

ESSENTIAL FUNCTIONS

• Support client with formulary rebate and utilization management strategies to service all current and future needs
• Participate in Clinical Program team functions including maintaining formulary status changes for all actively maintained formularies assessing utilization management policy updates and consulting on anticipated clinical and financial impacts of strategies under consideration by the client
• Keep abreast with industry pipelines such as new drugs patent expirations generic and biosimilar approvals and launch dates etc.
• Act in concert with internal teams such as Account Management to service all needs of the client
• Participate in developing tools and trainings for carrying out work plan goals including continuous process improvement activities
• Represent the strategic market division as a point of contact for various corporate clinical initiatives including participation in client meetings

QUALIFICATIONS

• B.S. in Pharmacy with experience or Doctor of Pharmacy
• Current U.S. pharmacist license
• Experience in PBM Pharmaceutical and Healthcare industry
• Experience with Pharmaceutical Contracts and Pharmacy Benefits strongly preferred
• Experience with clinical utilization criteria evaluation strongly preferred
• Excellent presentation and communication skills required
• Successfully function while handling multiple tasks and ability to prioritize
• Detail-oriented with strong organizational skills
• Ability to adapt in a dynamic work environment and learn quickly solve problems and make decisions with minimal assistance or direction from leader when interfacing with clients and other internal partners
• Ability to work independently and prioritize work to meet client needs
• Proficiency in Microsoft Office applications required

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy balanced and feel secure. Thats why youll enjoy a comprehensive range of benefits with a focus on supporting your whole health. Starting on day one of your employment youll be offered several health-related benefits including medical vision dental and well-being and behavioral health programs. We also offer 401(k) with company match company paid life insurance tuition reimbursement a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs visit Life at Cigna Group.

About Evernorth Health Services

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.