Remote Prior Authorization Representative Express Scripts Jobs in New Jersey

JOB SUMMARY

The Program Management Advisor will provide consultation to custom formulary clients through contract interpretation and rebate financial modeling. In this role, you will have the opportunity to identify strategic opportunities for clients to optimize their formulary to drive value for both internal and external organizations. This position works collaboratively with cross-functional teams and may assist with interdepartmental teams or projects to drive process improvements. Internally recognizedand trusted as the formulary rebate modeling subject matter expert.

For positions that are Flex/WFH: This role is Flex/WFH which allows most work to be performed at home or on occasion at a Cigna office location. Employees must be fully vaccinated if they choose to come onsite.

ESSENTIAL FUNCTIONS:

• Provide consultation through rebate contract interpretation and strategic opportunity identification
• Meet directly with large and complex custom clients to review modeling and cultivate relationships with Formulary Decision Makers (i.e. Pharmacy Directors, VP's, etc.).
• Evaluate client data, create scenarios, and provide expert formulary modeling and guidance for existing clients in alignment with department strategic objectives
• Collaborate with Clinical Account Executives to create strategy for Custom Clients based on formulary scenarios, rebate offerings, and modeling options.
• In collaboration with Clinical Account Executives, discuss with clients any potential utilization management programs under evaluation to ensure that all modeling and requirements of these programs are accurately represented and in alignment with Pharmaceutical rebate contract.
• Analyze the financial impact of client requested formulary changes to both the client and Express Scripts.
• Create presentations for client formulary strategy and/or consulting meetings including all supporting documentation.
• Participate in interdepartmental team calls as required to discuss rebate invoicing eligibility terms/conditions.
• Effectively document and communicate formulary analysis projects. (i.e., model maintenance and QC).
• Ensures optimization of work processes for formulary modeling strategies and achievement of department goals

QUALIFICATIONS:

• Bachelor Degree, Finance, Healthcare or related area/MBA a plus
• Pharm D a plus
• 2-4 years relevant work experience in PBM, Managed Care, Healthcare or Finance
• Confidence, Detail Oriented Organizational, and Analytical skills
• Excellent PC skills - including Excel, PowerPoint and MS Access, experience with database
• Must have expertise in Excel
• Financial modeling experience
• Familiarity with pharmaceutical rebate contracts a plus
• Proven ability to work in a fast paced - ever changing environment
• Excellent relationship building and cross functional skills
• Ability to travel approximately 10%.

ABOUT THE DEPARTMENT

Supply Chain - Custom Formulary consulting combines the coordination and management of the company's key supplier groups under a single management team. Major suppliers include brand and generic pharmaceutical manufacturers, retail pharmacies and drug wholesalers.

Express Scripts, a leading pharmacy benefit manager with the nation's largest mail order-pharmacy operations, assists its customers to moderate the cost and enhance the quality of prescription drug benefits provided to members nationwide. Its customers include private- and public-sector employers and healthcare organizations.

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.