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

Job Description

Provides advanced professional input to complex Operations Management assignments/projects.

Supports and provides direction to more junior professionals.

Works autonomously, only requiring "expert" level technical support from others.

Exercises judgment in the evaluation, selection, and adaptation of both standard and complex techniques and procedures.

Utilizes in-depth professional knowledge and acumen to develop models and procedures, and monitor trends, within Business Operations.

May lead projects or project steps within a broader project or have accountability for ongoing activities or objectives.

Essential Tasks


* Accurately review, document, and setup new clinical prior authorization requirements into appropriate applications.


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


* Accountable for timely and accurate translation of client intent into configuration


* Track and communicate status of service requests as necessary


* Assist in remediating process gaps and documenting best practices


* Meet with clients & clinical teams to discuss and provide key subject matter expertise on Pharmacy and Medical Criteria setup.


* Advise clients on the most efficient way to implement clinical PA intent within ESI applications.


* Consult with team members, SMEs and specialized teams as necessary, Clinical Account Teams, Product Owners


* Provide assistance to team members with issues needing clinical interpretation and guidance


* Self-manage and tracks all requests to ensure timelines are met including the


* proactive management of client specific performance guarantees.


* Develop a deep E2E understanding of our claims adjudication system and associated clinical applications


* Identify and help remediate any process gaps, develop and document best


* practices by creating or modifying existing to existing SOPS, process


* maps, references and intent forms


* Demonstrates 'Team Player' and collaborative skills within internal and external teams


* Takes risks by thinking strategically about problems and challenges within their domain


* Communicates effectively within peers, upstream, and downstream partners

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 preferred


* 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 95,100 - 158,500 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to partic...