Express Scripts Pharmacy Benefit Services
Clinical Program Advisor - Express Scripts - Hybrid (Strategic Markets - Prime)
Express Scripts Pharmacy Benefit Services, Saint Louis, Missouri, United States, 63146
Clinical Program Advisor – Express Scripts – Hybrid (Strategic Markets – Prime)
Hybrid position: 3 days per week in‑office plus 2 days work at home. Candidate may be based in any US Cigna Healthcare office.
The Clinical Program Advisor will review, consult, and evaluate utilization management criteria to align with pharmaceutical rebate contract requirements and provide quality assurance evaluations to promote accurate rebate invoicing. This role works cross‑functionally with Pharmaceutical Contracting, Clinical Consulting, and Pharmaceutical Invoicing teams to ensure formulary tier and clinical rules are interpreted correctly, and evaluates benefit set‑up impacts on rebated drug products. Reporting to the Clinical Program Director, this position supports documentation of formulary placement and utilization management policies and procedures for client eligibility determination for rebate enhancement and exclusion options. Additional duties include consultative support on rebate requirements in manufacturer agreements, advice on impact assessments following changes to formulary tiers, contracts, or management policies, acting as a point of contact for client clinical initiatives, completing financial/rebate impact assessments, maintaining formularies, 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 of industry pipelines, such as new drugs, patent expirations, generic and biosimilar approvals and launch dates.
Act in concert with internal teams, such as Account Management, to service all needs of the client.
Develop 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 (or Doctor of Pharmacy) with experience.
Current U.S. pharmacist license.
Experience in PBM, pharmaceutical, and healthcare industry.
Experience with pharmaceutical contracts and pharmacy benefits strongly preferred.
Experience with clinical utilization criteria evaluation strongly preferred.
Excellent presentation and communication skills required.
Successful function while handling multiple tasks and ability to prioritize.
Detail‑oriented with strong organizational skills.
Ability to adapt in a dynamic work environment and learn quickly, solve problems, and make decisions with minimal assistance or direction from a leader when interfacing with clients and other internal partners.
Ability to work independently and prioritize work to meet client needs.
Proficiency in Microsoft Office applications required.
For remote work, the internet connection must be obtained through cable broadband or fiber optic service with speeds of at least 10 Mbps download / 5 Mbps upload.
Annual salary: $95,100–$158,500 USD, depending on experience and location. Eligibility for an annual bonus plan.
Benefits Starting on day one, you’ll be offered a comprehensive health‑related benefits package, including medical, vision, dental, and behavioral health programs, 401(k) with company match, company‑paid life insurance, tuition reimbursement, at least 18 days of paid time off per year, and paid holidays.
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.
Equal Opportunity Statement 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 require reasonable accommodation in completing the online application process, please email
SeeYourself@cigna.com
for support. We do not accept emails for updates or resumes.
The Cigna Group has a tobacco‑free policy and reserves the right not to hire tobacco/nicotine users in states where this 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 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.
Seniority Level Mid‑Senior level
Employment Type Full‑time
Job Function Health Care Provider
Industries Hospitals and Health Care
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The Clinical Program Advisor will review, consult, and evaluate utilization management criteria to align with pharmaceutical rebate contract requirements and provide quality assurance evaluations to promote accurate rebate invoicing. This role works cross‑functionally with Pharmaceutical Contracting, Clinical Consulting, and Pharmaceutical Invoicing teams to ensure formulary tier and clinical rules are interpreted correctly, and evaluates benefit set‑up impacts on rebated drug products. Reporting to the Clinical Program Director, this position supports documentation of formulary placement and utilization management policies and procedures for client eligibility determination for rebate enhancement and exclusion options. Additional duties include consultative support on rebate requirements in manufacturer agreements, advice on impact assessments following changes to formulary tiers, contracts, or management policies, acting as a point of contact for client clinical initiatives, completing financial/rebate impact assessments, maintaining formularies, 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 of industry pipelines, such as new drugs, patent expirations, generic and biosimilar approvals and launch dates.
Act in concert with internal teams, such as Account Management, to service all needs of the client.
Develop 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 (or Doctor of Pharmacy) with experience.
Current U.S. pharmacist license.
Experience in PBM, pharmaceutical, and healthcare industry.
Experience with pharmaceutical contracts and pharmacy benefits strongly preferred.
Experience with clinical utilization criteria evaluation strongly preferred.
Excellent presentation and communication skills required.
Successful function while handling multiple tasks and ability to prioritize.
Detail‑oriented with strong organizational skills.
Ability to adapt in a dynamic work environment and learn quickly, solve problems, and make decisions with minimal assistance or direction from a leader when interfacing with clients and other internal partners.
Ability to work independently and prioritize work to meet client needs.
Proficiency in Microsoft Office applications required.
For remote work, the internet connection must be obtained through cable broadband or fiber optic service with speeds of at least 10 Mbps download / 5 Mbps upload.
Annual salary: $95,100–$158,500 USD, depending on experience and location. Eligibility for an annual bonus plan.
Benefits Starting on day one, you’ll be offered a comprehensive health‑related benefits package, including medical, vision, dental, and behavioral health programs, 401(k) with company match, company‑paid life insurance, tuition reimbursement, at least 18 days of paid time off per year, and paid holidays.
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.
Equal Opportunity Statement 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 require reasonable accommodation in completing the online application process, please email
SeeYourself@cigna.com
for support. We do not accept emails for updates or resumes.
The Cigna Group has a tobacco‑free policy and reserves the right not to hire tobacco/nicotine users in states where this 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 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.
Seniority Level Mid‑Senior level
Employment Type Full‑time
Job Function Health Care Provider
Industries Hospitals and Health Care
#J-18808-Ljbffr