... providing quality assurance evaluations that will promote accurate rebate invoicing ... This role will work cross-functionally with the Pharmaceutical Contracting, Clinical Consulting ...
... providing quality assurance evaluations that will promote accurate rebate invoicing ... This role will work cross-functionally with the Pharmaceutical Contracting, Clinical Consulting ...
Cigna Provider Contracting information
What is Cigna Provider Contracting?
Cigna Provider Contracting refers to the process by which healthcare providers, such as doctors, hospitals, and clinics, enter into agreements with Cigna, a major health insurance company. These contracts outline the terms, reimbursement rates, and requirements for providing care to Cigna’s insured members. The goal is to ensure a network of quality providers for members, while clarifying expectations and payment arrangements for both parties. Provider contracting specialists at Cigna negotiate these agreements and help maintain strong relationships with healthcare providers.
What are some common challenges faced in Cigna Provider Contracting roles, and how can they be effectively managed?
Professionals in Cigna Provider Contracting often encounter challenges such as negotiating mutually beneficial terms with providers, understanding complex regulatory requirements, and balancing organizational goals with provider expectations. Effective management of these challenges involves strong communication skills, a thorough knowledge of contract language and healthcare regulations, and the ability to build positive relationships with providers. Collaborating closely with legal, compliance, and network management teams also helps ensure contracts are both competitive and compliant.
What are the key skills and qualifications needed to thrive as a Cigna Provider Contracting professional, and why are they important?
To thrive in Cigna Provider Contracting, you need a strong understanding of healthcare contracting, negotiation strategies, and knowledge of provider networks, often supported by a degree in business, healthcare administration, or a related field. Familiarity with contract management systems, data analysis tools, and regulatory compliance platforms is typically required. Excellent interpersonal, communication, and problem-solving skills help professionals build positive relationships with providers and navigate complex agreements. These skills are crucial for ensuring competitive provider networks, compliance, and mutually beneficial partnerships in a dynamic healthcare environment.
What is the difference between Cigna Provider Contracting vs Cigna Network Analyst?
| Aspect | Cigna Provider Contracting | Cigna Network Analyst |
|---|---|---|
| Primary Role | Negotiates and manages provider agreements with healthcare providers | Analyzes network data to optimize provider networks and performance |
| Required Credentials | Healthcare administration, business, or related degree; experience in contracting | Data analysis, healthcare informatics, or related degree; analytical skills |
| Work Environment | Office-based, provider meetings, contract negotiations | Office-based, data analysis, reporting |
While Cigna Provider Contracting focuses on establishing and managing provider agreements, Cigna Network Analysts analyze network data to improve provider performance and network efficiency. Both roles require healthcare or data-related credentials and operate primarily in office settings, but their core functions differ—contracting versus data analysis.
What are popular job titles related to Cigna Provider Contracting jobs in Michigan?
For Cigna Provider Contracting jobs in Michigan, the most frequently searched job titles are:
What job categories do people searching Cigna Provider Contracting jobs in Michigan look for?
The top searched job categories for Cigna Provider Contracting jobs in Michigan are:
What cities in Michigan are hiring for Cigna Provider Contracting jobs?
Cities in Michigan with the most Cigna Provider Contracting job openings:
Clinical Program Advisor - Express Scripts - Hybrid (Strategic Markets)
On-site, Remote
Full-time
Medical, Dental, Vision, Life, Retirement, PTO
This job post has expired today. Applications are no longer accepted.
Cigna Healthcare rating
8.3
Based on 240 frontline employees who took The Breakroom Quiz
41st of 893 rated healthcare providers
Job description
The job profile for this position is Clinical Program Advisor, which is a Band 4 Senior Contributor Career Track Role.
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.
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JOB POSTING TITLE
Clinical Program Advisor - Express Scripts - Strategic Markets
JOB DESCRIPTION
POSITION SUMMARY
This role requires a clinical background, understanding of utilization management criteria, and ability to interpret pharmaceutical contracts. The Clinical Program Advisor will be responsible for review, consultation, and clinical evaluation of utilization management criteria to align with pharmaceutical rebate contract requirements and providing quality assurance evaluations that will promote accurate rebate invoicing. This role will work cross-functionally with the Pharmaceutical Contracting, Clinical Consulting, and Pharmaceutical Invoicing teams to ensure formulary tier and clinical rules are interpreted correctly and will evaluate benefit set up impacts on rebated drug products. Reporting to the Clinical Program Director, this position provides clinical support in documenting formulary placement/positioning and utilization management policies and procedures for the analysis and appropriate determination of client eligibility for rebate enhancement and exclusion options. Additionally, this role offers consultative clinical support in the interpretation of rebate requirements contained within manufacturer rebate agreements, as well as advice regarding impact assessments following any proposed or implemented changes to formulary tiers, contracts, or management policies. Additional responsibilities include acting as a point of contact for client’s clinical and formulary-related initiatives, completing financial/rebate impact assessments to evaluate utilization management strategies, conducting ongoing formulary maintenance and new formulary implementation reviews, 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 with industry pipelines, such as new drugs, patent expirations, generic and biosimilar approvals and launch dates, etc.
- Act in concert with internal teams, such as Account Management, to service all needs of the client
- Participate in developing tools and training for carrying out goals of work plans, 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 with experience or Doctor of Pharmacy
- Current U.S. pharmacist license
- Experience in PBM, Pharmaceutical and Healthcare industry
- Good to have – General knowledge of Medicare and/or Medicaid pharmacy benefits
- Experience with Pharmaceutical Contracts and Pharmacy Benefits strongly preferred
- Experience with clinical utilization criteria evaluation strongly preferred
- Excellent presentation and communication skills required
- Successfully function while handling multiple tasks and ability to prioritize
- Detail-oriented with strong organizational skills
- Ability to adapt to a dynamic work environment and learn quickly, solve problems, and make decisions with minimal assistance or direction from leader when interfacing clients and other internal partners
- Ability to work independently and prioritize work to meet client needs
- Proficiency in Microsoft Office applications required
This role is also anticipated to be eligible to participate in an annual bonus plan.
At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence. For more details on our employee benefits programs, click here .
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 .
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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About Cigna
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Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you'll enjoy meaningful career experiences that enrich people's lives.
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
Bloomfield, CT, US