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

POSITION SUMMARY

This role requires the combination of a strong clinical background, deep understanding of utilization management criteria, and ability to read pharmaceutical contracts, along with business acumen and financial analytical skills to identify and execute upon strategic opportunities that align with clinical/financial objectives.

The Clinical Program Senior Advisor, Strategic Markets 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 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


* Develop, prepare, and present clinical business strategies (formulary, utilization and/or health management strategy, support for client P&T and Business Committee meetings)


* 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, inc...