Clinical Program Advisor - Express Scripts - Hybrid (Strategic Markets - Prime)

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 and is not restricted to locations that are listed in this posting.

JOB DESCRIPTION

The Clinical Program Advisor will be responsible for review, consultation, and clinical evaluation of utilization management criteria to align with pharmaceutical rebate contract requirements and providing quality assurance evaluations that will promote accurate rebate invoicing.

This role will work cross-functionally with the Pharmaceutical Contracting, Clinical Consulting, and Pharmaceutical Invoicing teams to ensure formulary tier and clinical rules are interpreted correctly and will evaluate benefit set up impacts on rebated drug products.

Reporting to the Clinical Program Director, this position provides clinical support in documenting formulary placement/positioning and utilization management 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 formulary tiers, contracts, or management policies.

Additional responsibilities include acting as a point of contact for client's clinical and formulary-related initiatives, completing financial/rebate impact assessments to evaluate utilization management strategies, conducting ongoing formulary maintenance and new formulary implementation reviews, and identifying prospects for clinical program adoption.

ESSENTIAL FUNCTIONS


* Support client with formulary, rebate, and utilization management strategies to service all current and future needs


* Participate in Clinical Program team functions, including maintaining formulary status changes for all actively maintained formularies, assessing utilization management policy updates, and consulting on anticipated clinical and financial impacts of strategies under consideration by the client


* Keep abreast with industry pipelines, such as new drugs, patent expirations, generic and biosimilar approvals and launch dates, etc.


* Act in concert with internal teams, such as Account Management to service all needs of the client


* Participate in developing tools and trainings for carrying out work plan goals, including continuous process improvement activities


* Represent the strategic market division as a point of contact for various corporate clinical initiatives, including participation in client meetings

QUALIFICATIONS


* B.S.

in Pharmacy with experience or Doctor of Pharmacy


* Current U.S.

pharmacist license


* Experience in PBM, Pharmaceutical and Healthcare industry


* Experience with Pharmaceutical Contracts and Pharmacy Benefits strongly prefer...