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

Job Summary

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


* Responsible for the successful implementation of new client clinical programs, complete understanding of Express Script's clinical Medicare portfolio


* Work directly with client as needed for gathering of requirements and support of clinical benefit changes


* Identify and document client requirements and complete clinical portion of installation project plans


* Act as a subject matter expert (SME) in areas relevant to the team


* Develop strategic relationships/matrix with Clinical Operations and other Express Scripts leaders


* Leads, coaches, and develops by providing mentorship to members within the team


* Acts as a strategic business partner to various stakeholders both internal/external


* Lead and execute large strategic projects designed to enhance operating effectiveness and drive overall change


* Identify business improvement opportunities using data, feedback, and analysis


* Execute and deliver processes with a forward thinking ability to present solutions and identify efficiencies


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


* Serve as business owner to necessary client work that involve 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 develop...