Express Scripts Pharmacy Benefit Services
Clinical Program Advisor - Express Scripts - Hybrid (Strategic Markets - Prime)
Express Scripts Pharmacy Benefit Services, Bloomington, Minnesota, United States
Clinical Program Advisor - Express Scripts - Hybrid (Strategic Markets - Prime)
Join to apply for the
Clinical Program Advisor - Express Scripts - Hybrid (Strategic Markets - Prime)
role at
Express Scripts Pharmacy Benefit Services .
This is a Hybrid position (3 days per week in-office + 2 days work at home).
The candidate can be based out of any US Cigna Healthcare office; location is not restricted to those listed.
Job Description The Clinical Program Advisor will be responsible for reviewing, consulting, and clinically evaluating utilization management criteria to align with pharmaceutical rebate contract requirements and providing quality assurance evaluations to promote accurate rebate invoicing. The role works cross-functionally with Pharmaceutical Contracting, Clinical Consulting, and Pharmaceutical Invoicing teams to ensure formulary tier and clinical rules are interpreted correctly and to evaluate benefit set up impacts on rebated drug products. Reporting to the Clinical Program Director, the position provides clinical support in documenting formulary placement/positioning and utilization management policies and procedures for the analysis and determination of client eligibility for rebate enhancement and exclusion options. Additionally, the role offers consultative clinical support in interpreting rebate requirements in manufacturer rebate agreements and advice regarding impact assessments following any proposed or implemented changes to formulary tiers, contracts, or management policies.
Key Responsibilities
Support clients with formulary, rebate, and utilization management strategies to meet current and future needs.
Participate in Clinical Program team functions, maintaining formulary status changes for active formularies, assessing utilization management policy updates, and consulting on anticipated clinical and financial impacts.
Stay abreast of industry pipelines (new drugs, patent expirations, generic and biosimilar approvals and launch dates).
Collaborate with internal teams, such as Account Management, to service client needs.
Develop tools and training to support work plan goals, including continuous process improvement.
Represent the strategic market division as a point of contact for corporate clinical initiatives, including client meetings.
Qualifications
B.S. in Pharmacy or Doctor of Pharmacy.
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.
Ability to handle multiple tasks, prioritize, and work independently.
Detail-oriented with strong organizational skills.
Adaptability in a dynamic environment; solves problems with minimal direction.
Proficiency in Microsoft Office applications.
For occasional or permanent work at home: internet connection must be cable broadband or fiber optic with speeds of at least 10 Mbps download/5 Mbps upload.
Compensation & Benefits Annual salary range: $95,100 – $158,500 USD, depending on experience and geographic location. The role is also eligible to participate in an annual bonus plan.
Benefits include medical, vision, dental, and behavioral health programs; 401(k) with company match; company-paid life insurance; tuition reimbursement; a minimum of 18 days paid time off per year; paid holidays. For more details, visit Life at Cigna Group.
Seniority Level & Employment Type Mid-Senior level – Full-time. Job function: Health Care Provider. Industries: Hospitals and Health Care.
Equal Employment Opportunity 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 a reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email for an update on your application or to provide your resume.
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. 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. Candidates in those states who use tobacco/nicotine will not be considered unless they enter a qualifying smoking cessation program prior to employment.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
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Clinical Program Advisor - Express Scripts - Hybrid (Strategic Markets - Prime)
role at
Express Scripts Pharmacy Benefit Services .
This is a Hybrid position (3 days per week in-office + 2 days work at home).
The candidate can be based out of any US Cigna Healthcare office; location is not restricted to those listed.
Job Description The Clinical Program Advisor will be responsible for reviewing, consulting, and clinically evaluating utilization management criteria to align with pharmaceutical rebate contract requirements and providing quality assurance evaluations to promote accurate rebate invoicing. The role works cross-functionally with Pharmaceutical Contracting, Clinical Consulting, and Pharmaceutical Invoicing teams to ensure formulary tier and clinical rules are interpreted correctly and to evaluate benefit set up impacts on rebated drug products. Reporting to the Clinical Program Director, the position provides clinical support in documenting formulary placement/positioning and utilization management policies and procedures for the analysis and determination of client eligibility for rebate enhancement and exclusion options. Additionally, the role offers consultative clinical support in interpreting rebate requirements in manufacturer rebate agreements and advice regarding impact assessments following any proposed or implemented changes to formulary tiers, contracts, or management policies.
Key Responsibilities
Support clients with formulary, rebate, and utilization management strategies to meet current and future needs.
Participate in Clinical Program team functions, maintaining formulary status changes for active formularies, assessing utilization management policy updates, and consulting on anticipated clinical and financial impacts.
Stay abreast of industry pipelines (new drugs, patent expirations, generic and biosimilar approvals and launch dates).
Collaborate with internal teams, such as Account Management, to service client needs.
Develop tools and training to support work plan goals, including continuous process improvement.
Represent the strategic market division as a point of contact for corporate clinical initiatives, including client meetings.
Qualifications
B.S. in Pharmacy or Doctor of Pharmacy.
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.
Ability to handle multiple tasks, prioritize, and work independently.
Detail-oriented with strong organizational skills.
Adaptability in a dynamic environment; solves problems with minimal direction.
Proficiency in Microsoft Office applications.
For occasional or permanent work at home: internet connection must be cable broadband or fiber optic with speeds of at least 10 Mbps download/5 Mbps upload.
Compensation & Benefits Annual salary range: $95,100 – $158,500 USD, depending on experience and geographic location. The role is also eligible to participate in an annual bonus plan.
Benefits include medical, vision, dental, and behavioral health programs; 401(k) with company match; company-paid life insurance; tuition reimbursement; a minimum of 18 days paid time off per year; paid holidays. For more details, visit Life at Cigna Group.
Seniority Level & Employment Type Mid-Senior level – Full-time. Job function: Health Care Provider. Industries: Hospitals and Health Care.
Equal Employment Opportunity 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 a reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email for an update on your application or to provide your resume.
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. 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. Candidates in those states who use tobacco/nicotine will not be considered unless they enter a qualifying smoking cessation program prior to employment.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
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