Remote Prior Authorization Representative Express Scripts Jobs in New Jersey

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

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. For this position, we anticipate offering an annual salary of 95,500 - 159,100 USD / yearly, depending on relevant factors, including experience and geographic location.

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.

About Evernorth Health Services

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. 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 need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance.  Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

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.

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