Pharmacy Clinical Program Senior Advisor

3 weeks ago

Bloomfield Hills, Michigan, United States The Cigna Group Full time

Role Summary:

This position is responsible for developing formulary strategies involving pharmacy and medical products, clinical actions following new/existing drug product releases, evaluating and managing drug utilization review, and pipeline product tracking and forecasting.

Affordability solutions encompass activities such as utilization management edits at the 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.

Responsibilities:

  • Execute formulary management 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 opportunities for cross-benefit drug management in an integrated model.
  • Develop and implement utilization management strategies and drug utilization review programs to enhance formulary strategies and improve clinical outcomes in alignment with P&T determination.
  • Evaluate the success of current utilization management programs to determine areas of enhancement.
  • Organize and coordinate with a team of matrix partners and subject matter experts to assess opportunities to create non-condition-based clinical programs.
  • Track and interpret the impact of future market changes, including drug pipeline, regulatory activity, and new product offerings.
  • Provide clinical subject matter expertise to the release and placement of new medications across pharmacy and medical to client-facing partners.
  • Provide support to condition-based program managers to enhance clinical affordability and total health outcomes.
  • Coordinate with stakeholders to respond to RFP inquiries.
  • Coordinate with legal and compliance to ensure formulary strategies are in alignment with state and federal regulatory requirements.
  • Coordinate the execution of these actions with partners in Supply Chain, Medical Management, Contracting, Drug Policy, Specialty Pharmacy, Provider Network, and other areas that can impact results.
  • Provide education and training for the clinical team (Pharmacy Service Center, Home Deliver, Specialty Pharmacy, Medical Management) to communicate clinical strategy and actions and assure consistent execution of class strategy.
  • Other duties as assigned.

Qualifications:

  • PharmD preferred; advanced degree a plus.
  • Licensed Pharmacist required.
  • Minimum of 3 years Commercial formulary management experience required, preferably in a Health Plan or PBM setting.
  • Experience developing end-to-end Pharmacy Clinical Programs required.
  • Proven capabilities in strategic planning and clinical program development required.
  • Solid understanding of evidence-based medicine, interpreting clinical literature, and standards of care required.
  • Demonstrated ability to work in a highly matrixed environment.
  • Results-driven with proven communication, interpersonal, and collaboration skills working in a cross-functional and matrixed environment.


We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health.

We also offer 401(k) with company match, company-paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, and paid holidays.

For more details on our employee benefits programs, visit Life at Cigna Group.


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 healthcare system, empowering them with the information and insight they need to make the best choices for improving their health and vitality.

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.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state, and local ordinances.

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.

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