Job Description

POSITION SUMMARY

The Clinical Program Sr. Advisor is responsible for assessing formulary positioning alongside applicable utilization management policies to determine client eligibility for rebates, ultimately providing quality assurance evaluations that will promote accurate rebate invoicing. This role will work cross-functionally with the Pharma Contracting, Formulary Consulting, Clinical Account Executive, and Pharma Invoicing teams to ensure clinical rules are interpreted correctly and will evaluate benefit set up impacts on rebated drug products. Reporting to the Clinical Program Sr. Manager, this position provides clinical support in documenting 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 contracts or management policies.

ESSENTIAL FUNCTIONS

• Perform timely rule review quality assurance evaluations in support of colleagues completing ongoing maintenance reviews of existing formularies and implementations of new formularies.
• Provides advice and counsel regarding upcoming client clinical changes (utilization management changes received retrospectively, as well as prospective policy update consultations).
• Assist Clinical Program Sr. Manager with preparation for monthly proactive invoicing reviews across categories of competing products within a therapy class or grouping.
• Responsible for assisting colleagues with monitoring reports and proactively performing analyses to report findings to internal/external clients, particularly when clinical insight is required.
• Provides consultative clinical support in the interpretation of rebate requirements contained within manufacturer rebate agreements.
• Provides consultative support determining rebate impacts due to considered changes to formulary and benefits on rebate eligible products.
• Develop and document appropriate policy and procedures for analysis and appropriate determination of client eligibility for rebate enhancement and exclusion options. Continually update documents as processes change and review at a minimum on an annual basis.
• Review clinical utilization criteria and compare to Pharma contracts to ensure accurate invoicing of each product.
• Interpret complex contract changes to determine impact to rebates.
• Mentor and support colleagues in training and understanding of more clinical scenarios.
• Identifies, recommends and leads process improvement efforts.
• Manages medium risk client escalations.
• Other duties as assigned.

QUALIFICATIONS

• B.S. in Pharmacy, Doctor of Pharmacy.
• 5-7 years of experience in PBM, Pharmaceutical, or Healthcare industry.
• Strong analytical, planning, problem identification and resolution skills required.
• Demonstrated self- initiative.
• Effective communication with internal and external individuals in various functional areas and at all levels of management.
• Knowledge of ESI\'s products and services preferred.
• Experience with Pharmaceutical Contracts and/or Pharmacy Benefits strongly preferred.
• Experience with clinical criteria evaluation.
• Understanding of and experience with quality and process improvement concepts, methodologies.
• Proven ability to plan for and integrate multiple tasks concurrently as well as work independently.

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 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: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com 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.

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