Clinical Program Director

1 month ago

West Bloomfield Township, Michigan, United States The Cigna Group Full time
The job profile for this position is Clinical Program Director, which is a Band 5 Management Career Track Role.

Excited to grow your career?

We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply

Our people make all the difference in our success.

This is a 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 offi

RESPONSIBILITIES:

  • Responsible for the commercial formulary change process evaluating pharmacy and medical drug strategy opportunities and formulary product enhancements to drive pharmacy affordability to Cigna Health Plan clients
  • Responsible for the development of complex utilization management strategies and drug utilization review programs to enhance formulary strategies and improve clinical outcomes in alignment with the clinical determination of the Pharmacy and Therapeutics Committee
  • Ensures the clinical integrity of the Health Plan pharmacy offering
  • Partners with Health Plan and Health Services Product teams and Supply Chain to evaluate and deploy available Health Services solutions that meet Health Plan clinical and affordability goals.
  • Develops differentiated prescription drug benefit affordability capabilities that meet the unique needs of the buying groups and funding types within the Health Plan book of business.
  • Responsible for ensuring downstream implementation processes are efficient and support the continuous development business strategies
  • Partner with Federal/State government affairs in health plan drug-related issues to foster a favorable regulatory environment
  • Ensure regulatory compliance by reviewing new state mandates and updating internal processes to support adherence
  • Provides clinical and contextual insights to partners within the Health Plan finance, underwriting, and risk-bearing products to ensure that emerging therapeutics and revisions to the US drug supply are accurately reflected in financial projections (trend, underwriting, and pricing).
  • Partner with the Health Plan Medical organization to support discussions with professional societies about complex and/or controversial formulary changes where engagement with external organizations is needed
  • Provides clinical support to the Integrated Health Plan pharmacy client-facing teams, responding to RFP requests, and evaluating client customization requests
  • Responsible for training/onboarding and ongoing development of new team members on formulary processes and policies
  • Builds, develops and inspires a high performing pharmacy team and culture:
    • Creates a sense of purpose/meaning for the team that aligns with Cigna's value and mission.
    • Supports and promotes appropriate team alignment and process improvement work.
    • Provides coaching and development to teams, in particular, direct reports for succession planning and overall career growth.
    • Fosters an effective work environment and ensures employees receive appropriate communication, recognition and development.

REQUIRED SKILLS:

  • Registered Pharmacist required with active licensure in a US state or territory; advanced degree a plus
  • Previous experience in developing clinical programs related to Formulary and Utilization management required
  • Minimum of 6 years experience in the healthcare industry, with focus on Pharmacy Health Plan or Pharmacy Benefit Management.
  • Proven capabilities in strategic planning and large-scale project management.
  • Demonstrated ability to think/act strategically from a program value perspective and influence key leaders and matrix partners.
  • Demonstrated ability to work in a highly matrixed environment.
  • Strong communication and facilitation skills with all levels of the organization, including ability to resolve issues and build consensus among groups of diverse internal/external stakeholders.

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.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.

Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.

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