Clinical Program Advisor - Express Scripts - Remote (Centene)

Express Scripts Pharmacy Benefit Services; United States; Remote; USD 96,000 - 159,000; Full time

Benefits offered by this job

Annual bonus plan

Health, vision, dental benefits

401(k) plan

Paid time off

Job summary

The Cigna Group seeks an experienced Clinical Program Manager to counsel executives, coordinate cross‑functional programs, and provide strategic, data‑driven leadership across disciplines.

You will educate and enable care coordination, lead major client projects, and drive improvements in cost, quality, and satisfaction. Compensation ranges $95,500–$159,100 annually with bonus eligibility and comprehensive benefits.

Qualifications

• Current U.S. Pharmacist License, Pharm.D. required.
• Experience in managed care, PBM, or pharmaceutical sales preferred.
• Proven leadership, teamwork, proactive management, and strong client service.
• Knowledge of PBM/Managed care or value-based healthcare is desirable.

Responsibilities

• Act as SME in areas relevant to the team.
• Leads, coaches and mentors team members.
• Partners as strategic business partner to internal/external stakeholders.
• Leads large strategic projects to enhance operating effectiveness and drive change.
• Identifies business improvement opportunities using data, feedback, and analysis.
• Delivers processes with forward-thinking solutions and efficiencies.
• Participates in training and professional development activities.
• Owns client work involving operational and implementation benefits changes.
• Understands client's clinical-benefit philosophy to minimize clarifications.
• Captures and documents clinical benefit requirements with stakeholders.
• Provides excellent customer service and acts as a trusted client advisor.
• Collaborates with internal partners to vet implications.
• Consults with SMEs, Account Teams, and Product Owners.
• Manages and tracks all requests to meet timelines.
• Develops understanding of claims adjudication system and clinical applications.
• Leads project plans and delivery for each client.

Skills

Multitask effectively

Excel & Access

Written & verbal communication

Project management

Internal reporting tools

Administrative support & escalation

Medicare experience

Education

Pharm.D.

PBM/Managed care experience

Leadership & client service

PBM/Managed care knowledge

Job description

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

• Act as a subject matter expert (SME) in areas relevant to the team.
• 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.
• Consult with team members, SMEs and specialized teams as necessary, Client Benefit Administrators (CBA), Clinical Application Teams (DCRS, FRS, CRS, Criteria), Account Teams, 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 development, preparation, and presentation of project plan including execution and delivery for each client(s) assigned.

Skills

• Ability to multitask and communicate effectively.
• Microsoft office with a strong understanding of Excel and Access
• Written and verbal communication (listening, feedback; translating complex ideas/processes), collaboration, analytical thinking/critical thinking, results-oriented and organizational skills
• Must have the ability to work on multiple tasks, prioritize, resolve complex issues, and have strong project management skills
• Ability to learn multiple internal reporting and analytic tools for client management
• Provide project and administrative support to the team and **escalate** issues, risks, concerns as needed.
• Medicare experience preferred but not required.

Education And Qualifications

• Current U.S. Pharmacist License, Pharm.D.
• Managed care, the Pharmacy Benefit Manger (PBM) industry, or pharmaceutical sales preferred.
• Proven leadership skills, team-orientation, a proactive management style and strong commitment to client service a must.
• 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 95,500 - 159,100 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence. For more details on our employee benefits programs, click here.

About Evernorth Health Services

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you need a reasonable accommodation to complete the online application process, please email [e-mail] for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

The Cigna Group has a tobacco‑free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.