Senior Advisor, Pharmacy UM Strategy & Operations Cigna Healthcare Hybrid
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Job Location:
Saint Louis, MI - USA
Monthly Salary:
Not Disclosed
Posted on:
3 days ago
Vacancies:
1 Vacancy
Job Summary
The Business Project Senior Advisor will report to the Cigna Pharmacy Business UM Operationalization team and play a critical role in leading and supporting high-profile initiatives and complex issue resolution. This role requires deep expertise in pharmacy and medical claims prior authorization (PA) and utilization management (UM) operations and benefit configuration.
The position serves as a CHC health plan subject matter expert (SME) ensuring formulary strategy intent operational feasibility compliance and contract guardrails and downstream member and provider impacts are fully consideredparticularly within enterprise initiatives where PBM or medical-forward assumptions may not account for pharmacy versus medical benefit complexity.
Responsibilities
- Lead and/or support high-visibility business projects impacting CHC drug UM operations ensuring CHC health plan needs are represented throughout design build testing and implementation.
- Serve as an SME on UM systems and operational workflows including authorization behavior under both pharmacy and medical benefits and downstream impacts to operations and communications.
- Investigate complex escalations by validating true root cause using claims and benefit configuration data and UM operational knowledge; distinguish perceived issues from defects configuration gaps or process breakdowns.
- Analyze and interpret large datasets (claims benefit files UM outcomes) to quantify impact identify patterns and recommend sustainable end-to-end solutions.
- Translate business strategy and compliance or contract requirements into clear operational requirements and guardrails for cross-functional partners (operations technology and build teams).
- Present solution options with risks benefits and tradeoffs related to patient and prescriber experience affordability compliance exposure and operational feasibility; provide clear recommendations to leadership.
- Support AHIP-related drug benefit and UM initiatives including problem-solving for fallout scenarios and process gaps.
- Drive communication in a highly matrixed environment with exposure to senior leadership; keep leadership informed and escalate risks or roadblocks as needed.
- Perform other duties as assigned.
Requirements
- Bachelors degree preferred or 10 years of relevant drug prior authorization experience.
- Extensive knowledge of pharmacy and medical benefit UM operations and claims processing.
- Strong analytical skills with experience working with large datasets.
- Proven ability to lead complex initiatives and influence across matrixed teams.
- Clear concise communication skills with the ability to present to senior leadership.
If you will be working at home occasionally or permanently the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
About Cigna Healthcare
Cigna Healthcare a division of The Cigna Group is an advocate for better health through every stage of life. We guide our customers through the health care system empowering them with the information and insight they need to make the best choices for improving their health and vitality. 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 IC
Key Skills
- Computer Hardware
- Loan Processing
- Sales Experience
- Continuous Integration
- Iis
- Risk Management
- Banking
- Strategic Planning
- Curriculum Development
- Administrative Experience
- Program Design
- negotiation
About Company
Cigna Healthcare offers health insurance plans such as medical and dental to individuals and employers, international health insurance, and Medicare coverage.
