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

Cigna Health and Life Insurance Company; Northern (KY); Hybrid; USD 96,000 - 159,000; Full time

Benefits offered by this job

Medical

Vision

Dental

Well-being and behavioral health

401(k)

Company paid life insurance

Tuition reimbursement

Minimum of 18 days of paid time off

Paid holidays

Leaves of absence

Job summary

The Cigna Group is seeking an experienced Clinical Program Manager to counsel top management on Medicare program changes and coordinate across organizations. You will educate and enable care coordination with stakeholders to optimize healthcare experiences.

You will serve as a clinical advisor to the sales organization, delivering product/industry knowledge that improves cost, quality, and customer satisfaction.

Qualifications

• Current U.S. Pharmacist License and Pharm.D. required.
• Minimum 3 years licensure experience in managed care or PBM preferred.
• Knowledge of PBM/Managed care/Value Based healthcare desirable.
• If working from home, broadband internet speeds of at least 10Mbps/5Mbps are required.

Responsibilities

• Serve as business owner for Medicare-related client work and changes.
• Capture and document clinical benefit requirements with stakeholders.
• Provide excellent customer service and act as trusted advisor to clients.
• Collaborate with internal partners to vet implications of clinical benefit requests.
• Provide SME support to CAE/IPM, CBA, and clinical teams.
• Manage and track all requests to meet timelines.
• Develop understanding of claims adjudication system and related apps.
• Lead project plan development, execution, and client delivery.
• Participate in training and professional development activities.

Skills

Excel & Access

Multitasking

Communication

Project management

Timeline management

Collaborative work

Problem solving

Education

Pharm.D.

Pharmacist license (U.S.)

Job description

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

• Serve as business owner to necessary client work that involves Medicare 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 development, preparation, and presentation of project plan including execution and delivery for each client(s) assigned
• Participates and contributes in formal and informal training programs and professional development activities which may include taking, developing, and/or conducting sessions

Skills

• Ability to multi task 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 elevate issues, risks, concerns as needed
• Ability to manage timelines and meet tight client deadlines
• Advanced problem solving skills and the ability to work collaboratively with other departments to create solutions and to resolve issues
• Must be able to work under pressure and perform continual follow up in a timely manner in order to meet tight deadlines

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
• 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.

• Medical
• Vision
• Dental
• Well-being and behavioral health programs
• 401(k)
• Company paid life insurance
• Tuition reimbursement
• Minimum of 18 days of paid time off per year
• Paid holidays
• Leaves of absence

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
• Washington State

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

Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.