Clinical Program Senior Advisor - Cigna Healthcare - Hybrid (UM Policy Alignment Strategist)

Cigna Health and Life Insurance Company; Missouri; Hybrid; USD 116,000 - 194,000; Full time

Job summary

Cigna Healthcare is seeking a Clinical Program Senior Advisor to ensure UM policies align with clinical guidance in a hybrid role. Candidates should hold a Bachelor's in Pharmacy, possess at least four years of relevant experience, and be licensed pharmacists. This role emphasizes collaboration with drug policy teams to optimize formularies, requiring strong analytical and problem-solving skills.

Benefits

Health coverage

401(k) match

Life insurance

Tuition reimbursement

Paid time off

Qualifications

• Licensed Pharmacist required.
• At least 4 years of experience in healthcare utilization management or related field.
• Understanding of drug prior authorization regulations at state and federal levels.

Responsibilities

• Cross-reference clinical criteria with formulary and contract requirements.
• Consult with formulary strategists on policy impacts.
• Document findings clearly and effectively.

Skills

Analytical skills

Problem-solving skills

Strategic skills

Organizational skills

Communication skills

Education

Bachelor’s Degree in Pharmacy

PharmD

Tools

Microsoft Excel

Microsoft Access

Job description

Clinical Program Senior Advisor - Cigna Healthcare - Hybrid (UM Policy Alignment Strategist)

Apply remote type: Hybrid | Locations: St. Louis, MO; Bloomfield, CT; Bloomington, MN; Morris Plains, NJ | Full-time | Posted 2 Days Ago | Job Requisition ID: 25003566

This is a hybrid position (3 days in-office + 2 days remote). The candidate can be based out of any US Cigna Healthcare office.

This role requires office presence per Cigna policy but is not restricted to the locations listed.

Overview

The UM Policy Alignment Strategist Sr Advisor in Cigna Pharmacy Business UM operations will ensure UM policies align with clinical guidance, formulary intent, and operational feasibility. The role involves collaboration with drug policy, formulary strategy teams, and other partners to assess business impacts and contract adherence, requiring a detail-oriented and analytical individual.

Responsibilities

1. Cross-reference clinical criteria with formulary and contract requirements to ensure alignment and mitigate financial risk.
2. Consult with formulary strategists on policy impacts and facilitate variance requests as needed.
3. Identify opportunities to align policies with enterprise standards.
4. Participate in formulary strategy discussions to ensure formulary intent is maintained.
5. Collaborate with formulary and clinical teams on GCN expansion, documentation, review levels, and authorization durations to balance savings and efficiency.
6. Work with business requirement teams to optimize system setups.
7. Serve as a subject matter expert in formulary strategy meetings to identify risks and barriers.
8. Understand and ensure the integrity of prior authorization, coverage review, and claims adjudication processes.
9. Use team tools to input work requests and collaborate on resolving complex issues.
10. Document findings clearly and effectively.
11. Perform other duties as assigned.

Required Skills

1. Bachelor’s Degree in Pharmacy required; PharmD preferred.
2. Licensed Pharmacist required.
3. At least 4 years of experience in healthcare utilization management or related field.
4. Deep understanding of drug prior authorization regulations at state and federal levels.
5. Familiarity with NCPDP, URAC, NCQA standards.
6. Ability to work independently and adapt to changing environments.
7. Act with urgency in a fast-paced setting.
8. Strong strategic, analytical, and problem-solving skills.
9. Experience with clinical criteria development or analysis is a plus.
10. Proficiency in Microsoft Office, especially Excel and Access.
11. Excellent organizational skills and multi-project management.
12. Willingness to travel up to 10% as needed.

Additional Information

Home internet must be broadband or fiber with at least 10Mbps download/5Mbps upload speeds.

Estimated annual salary: $116,200 - $193,600, plus potential annual bonus.

Comprehensive benefits include health coverage, 401(k) match, life insurance, tuition reimbursement, paid time off, and holidays. More info at Life at Cigna Group.

About Cigna Healthcare

Cigna Healthcare, part of The Cigna Group, promotes health at every life stage, guiding customers through the healthcare system with insights to improve health and vitality. Join us to drive growth and impact lives.

We are committed to diversity and equal opportunity. Reasonable accommodations are available upon request via email at [e-mail].

Note: The Cigna Group maintains a tobacco-free policy and may not hire tobacco/nicotine users in certain states unless participating in a cessation program. Consideration of criminal histories is in accordance with laws.