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Clinical Program Senior Manager

3 months ago

St Louis, Missouri, United States The Cigna Group Full time

Role Summary:

This position is responsible for the oversite of implementation activities related to formulary management and utilization management on the pharmacy and medical benefit to ensure affordability targets are achieved, compliance with regulatory requirements, and business strategy intent is met. Affordability solutions encompass activities that include utilization management edits at point of service, preferred drug list strategy, retrospective utilization review, risk management review and condition-specific interventions. The position works closely with Matrix partners across the medical organization, PBM partners, Contracting, Pharmacy pricing/finance, Clinical Operations, Coverage Policy Unit, Pharmacy and Medical client facing partners, Pharmacy product, Analytics, Compliance, Legal, and Specialty Pharmacy. This position is responsible for the management of the clinical pharmacists who work to support formulary management activities as well as oversight of key functions that the clinical pharmacists are aligned to.

Responsibilities:

  • Lead a team of clinical pharmacists with day-to-day formulary management activities
  • Execute implementation strategies for major specialty and non-specialty drug classes across the pharmacy and medical benefit, including designing and implementing specific actions and workflows to drive affordability and meet quarterly targets
  • Evaluate the success of current utilization management programs to determine areas of enhancement
  • Monitor market share leakage for non-formulary drugs and implement strategies to address leakage and waste in the commercial population
  • Provide education and training for clinical teams (Pharmacy Service Center, Home Delivery, Specialty Pharmacy, Medical Management) to communicate clinical strategy and actions and assure consistent execution of class strategy
  • Responsible for the oversight of the review and audit of all Health Plan Value Assessment Committee recommendations/decisions to ensure all formularies are compliant with P&T guidelines
  • Responsible for the oversight of all state audits and updated regulatory requirements to ensure that the formulary management process and decisions of the Health Plan Value Assessment Committee are in line with state and federal regulations
  • Responsible for post-implementation affordability monitoring related to clinical issues resulting in loss of affordability
  • Responsible for the oversight of the new drug management process for pharmacy and medical drugs
  • Responsible for the oversight and monitoring of clinical research tasks to support the formulary strategy leads
  • Responsible for the oversight of periodic auditing and maintenance of existing drug lists related to compliance/legal mandates, product, and Back End formulary maintenance logic
  • Responsible for engaging with Matrix partners to identify potential impacts to formulary strategies

Qualifications:

  • PharmD preferred
  • Licensed Pharmacist required
  • Previous management experience required
  • Experience with formulary/utilization management implementation activities in a PBM and/or HealthPlan environment required
  • Minimum of 4 years Clinical Pharmacy experience required, preferably in a Pharmacy Benefit Management (PBM) and/or Health Plan
  • Proven capabilities in strategic planning, auditing,
  • Solid understanding of evidence-based medicine, interpreting clinical literature, and standards of care required
  • Demonstrated ability to work in a highly matrixed environment
  • Demonstrated ability to present to and engage with senior leaders
  • Results driven with proven communication, interpersonal and collaboration skills working in a cross-functional and matrixed environment require

This position is a Hybrid role where the Cigna policy requires office alignment but is not restricted to locations that are identified in this posting.

Hybrid position (3 days per week in-office + 2 days work at home). The incumbent candidate can be based out of any US Cigna Healthcare office.

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.

About Cigna Healthcare

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. 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 require reasonable accommodation in completing the online application process, please email: (see below) for support. Do not email (see below) for an update on your application or to provide your resume as you will not receive a response.

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.