Clinical Program Advisor - Express Scripts - Remote (Clinical Operations)

Job Description

Provides counsel and advice to top management on significant Clinical Program Management matters, often requiring coordination between organizations. Focuses on providing thought leadership and technical expertise across multiple disciplines. Recognized internally as “the go-to person” for the most complex Clinical Program Management assignments. Represents company externally and serves as conduit to educate and enable care coordination between stakeholders resulting in an optimal healthcare experience and customer satisfaction. Serves as clinical advisor to the sales organization, providing ongoing product and industry knowledge/education that positively influence cost, quality and customer satisfaction.

Essential Functions

• Serve as business owner to necessary client work that involves Medicare operational and implementation benefits changes

• Understand client's existing clinical benefit and business philosophy to help avoid unnecessary clarifications

• Accurately capture and document clinical benefit requirements in collaboration with business stakeholders

• Provide excellent customer service and act as a trusted client advisor

• Work with internal partners to ensure all implications of requested clinical benefit requirements are vetted, understood and communicated as necessary

• Provide operational Subject Matter Expertise (SME) to Clinical Account Executives/Implementation Manager (CAE/IPM’s), Client Benefit Administrators (CBA), Clinical Application Teams (DCRS, FRS, CRS, Criteria), Product Owners

• Manages and tracks all requests to ensure timelines are met

• Develop a deep understanding of claims adjudication system and associated clinical applications

• Leads the development, preparation, and presentation of project plan including execution and delivery for each client(s) assigned

• Participates and contributes in formal and informal training programs and professional development activities which may include taking, developing, and/or conducting sessions

Skills

• Ability to multi task and communicate effectively

• Microsoft office with a strong understanding of Excel and Access

• Written and verbal communication (listening, feedback; translating complex ideas/processes), collaboration, analytical thinking/critical thinking, results-oriented and organizational skills

• Must have the ability to work on multiple tasks, prioritize, resolve complex issues, and have strong project management skills

• Ability to learn multiple internal reporting and analytic tools for client management

• Provide project and administrative support to the team and escalate issues, risks, concerns as needed

• Ability to manage timelines and meet tight client deadlines

• Advanced problem solving skills and the ability to work collaboratively with other departments to create solutions and to resolve issues

• Must be able to work under pressure and perform continual follow up in a timely manner in order to meet tight deadlines

Education and Qualifications

• Current U.S. Pharmacist License, Pharm.D.

• Minimum of 3 years licensure experience preferred in managed care or with previous PBM experience

• Knowledge of PBM industry/Managed care/Value Based healthcare industry is desirable

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.For this position, we anticipate offering an annual salary of 120,000 - 200,000 USD / yearly, depending on relevant factors, including experience and geographic location.

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

At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence. For more details on our employee benefits programs, click here .

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 need a reasonable accommodation to complete the online application process, please email View email address on aiapply.co for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

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.