Clinical Program Senior Advisor - Cigna Healthcare - Hybrid (UM Policy Alignment Strategist)

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.

This position is a Hybrid role where the Cigna policy requires office alignment but is not restricted to locations that are identified in this posting.

Overview

The Cigna Pharmacy Business UM operations team UM Policy Alignment Strategist Sr Advisor will hold a key role in in ensuring that our utilization management (UM) policies align with clinical guidance, drive formulary intent, and are operationally feasible to implement.

The successful candidate will work closely with the drug policy team, formulary strategy teams, and other matrixed partners to assess for UM policies business impacts and contract adherence.

This role requires a highly skilled and detail-orientedperson with the ability to synthesize information from multiple sources.

Responsibilities


* Cross reference proposed clinical criteria against formulary intent and pharmaceutical contract requirements to ensure alignment and prevent financial risk to the business


* Act as a consultant to formulary strategists to communicate all policy impacts and work with drug policy team to facilitate variance requests when appropriate


* Seek opportunities where possible to align to an enterprise policy approach


* Act as a key collaborator in formulary strategy discussions (i.e.

Vision & Value) to understand formulary intent is preserved


* Act as a key collaborator with formulary strategy and clinical review teams to ensure alignment around GCN expansion, documentation requirements, level of review, and authorization duration requirement to drive a balance between affordability savings and operational efficiencies


* Collaborate closely with business requirement and criteria build team members to leverage system setup to optimize


* Act as a subject matter expert in formulary strategy meetings (I.e.

Vision & Value) to understand formulary intent of a strategy and identify risks or barriers to policy criteria


* Possess a working knowledge of formulary prior authorization, & coverage review determination processes and claims adjudication and ensure end to end process is not broken.


* Utilize team tools and resource to input work requests to business requirement and criteria build teams


* Collaborate with cross-functional partners to resolve complex issues.


* Document findings in a clear and relevant manner.


* Other tasks as assigned.

Required Skills


* Bachelor's Degree in Pharmacy required; PharmD preferred


* Licensed Pharmacist required


* Minimum of 4 years of experience in healthcare utilization management or a related field.


* In depth understanding of regulatory and compliance requirements for drug prior authorization at both state and federal level.


* Familiarity with industry standards organizations, preferably National Council for Prescription Drug Pro...