Clinical Program Senior Advisor - Cigna Healthcare - Hybrid (UM Policy Alignment Strategist) in Saint Louis, MO
Job title: Clinical Program Senior Advisor - Cigna Healthcare - Hybrid (UM Policy Alignment Strategist) in Saint Louis, MO at Cigna
Company: Cigna
Job description: 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 office.This position is a Hybrid role where the Cigna policy requires office alignment but is not restricted to locations that are identified in this posting.OverviewThe Cigna Pharmacy Business UM operations team UM Policy Alignment Strategist Sr Advisor will hold a key role in in ensuring that our utilization management (UM) policies align with clinical guidance, drive formulary intent, and are operationally feasible to implement. The successful candidate will work closely with the drug policy team, formulary strategy teams, and other matrixed partners to assess for UM policies business impacts and contract adherence. This role requires a highly skilled and detail-orientedperson with the ability to synthesize information from multiple sources.Responsibilities
Cross reference proposed clinical criteria against formulary intent and pharmaceutical contract requirements to ensure alignment and prevent financial risk to the business
Act as a consultant to formulary strategists to communicate all policy impacts and work with drug policy team to facilitate variance requests when appropriate
Seek opportunities where possible to align to an enterprise policy approach
Act as a key collaborator in formulary strategy discussions (i.e. Vision & Value) to understand formulary intent is preserved
Act as a key collaborator with formulary strategy and clinical review teams to ensure alignment around GCN expansion, documentation requirements, level of review, and authorization duration requirement to drive a balance between affordability savings and operational efficiencies
Collaborate closely with business requirement and criteria build team members to leverage system setup to optimize
Act as a subject matter expert in formulary strategy meetings (I.e. Vision & Value) to understand formulary intent of a strategy and identify risks or barriers to policy criteria
Possess a working knowledge of formulary prior authorization, & coverage review determination processes and claims adjudication and ensure end to end process is not broken.
Utilize team tools and resource to input work requests to business requirement and criteria build teams
Collaborate with cross-functional partners to resolve complex issues.
Document findings in a clear and relevant manner.
Other tasks as assigned.
Required Skills
Bachelor's Degree in Pharmacy required; PharmD preferred
Licensed Pharmacist required
Minimum of 4 years of experience in healthcare utilization management or a related field.
In depth understanding of regulatory and compliance requirements for drug prior authorization at both state and federal level.
Familiarity with industry standards organizations, preferably National Council for Prescription Drug Programs (NCPDP), URAC, and NCQA accreditation.
Ability to work independently and adapt quickly to changing environments.
Acts with urgency in a fast-paced environment with competing priorities.
Excellent strategic thinking and problem-solving abilities.
Process optimization and efficiency improvement
Strong analytical and decision-making skills
Previous experience developing or analyzing clinical criteria in relation to formulary management a strong plus.
Proficiency in Microsoft Office, including Excel and Access.
Strong organizational skills and ability to manage multiple projects.
Ability to work in a fast-paced environment with a sense of urgency
Ability to travel as needed up to 10%
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 116,200 - 193,600 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.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. 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) 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 HealthcareCigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. 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 require reasonable accommodation in completing the online application process, please email: [email protected] for support. Do not email [email protected] for an update on your application or to provide your resume as you will not receive a response.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.
Expected salary: $116200 - 193600 per year
Location: Saint Louis, MO
Job date: Mon, 28 Apr 2025 22:19:26 GMT
Apply for the job now!
Apply Now
Company: Cigna
Job description: 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 office.This position is a Hybrid role where the Cigna policy requires office alignment but is not restricted to locations that are identified in this posting.OverviewThe Cigna Pharmacy Business UM operations team UM Policy Alignment Strategist Sr Advisor will hold a key role in in ensuring that our utilization management (UM) policies align with clinical guidance, drive formulary intent, and are operationally feasible to implement. The successful candidate will work closely with the drug policy team, formulary strategy teams, and other matrixed partners to assess for UM policies business impacts and contract adherence. This role requires a highly skilled and detail-orientedperson with the ability to synthesize information from multiple sources.Responsibilities
Cross reference proposed clinical criteria against formulary intent and pharmaceutical contract requirements to ensure alignment and prevent financial risk to the business
Act as a consultant to formulary strategists to communicate all policy impacts and work with drug policy team to facilitate variance requests when appropriate
Seek opportunities where possible to align to an enterprise policy approach
Act as a key collaborator in formulary strategy discussions (i.e. Vision & Value) to understand formulary intent is preserved
Act as a key collaborator with formulary strategy and clinical review teams to ensure alignment around GCN expansion, documentation requirements, level of review, and authorization duration requirement to drive a balance between affordability savings and operational efficiencies
Collaborate closely with business requirement and criteria build team members to leverage system setup to optimize
Act as a subject matter expert in formulary strategy meetings (I.e. Vision & Value) to understand formulary intent of a strategy and identify risks or barriers to policy criteria
Possess a working knowledge of formulary prior authorization, & coverage review determination processes and claims adjudication and ensure end to end process is not broken.
Utilize team tools and resource to input work requests to business requirement and criteria build teams
Collaborate with cross-functional partners to resolve complex issues.
Document findings in a clear and relevant manner.
Other tasks as assigned.
Required Skills
Bachelor's Degree in Pharmacy required; PharmD preferred
Licensed Pharmacist required
Minimum of 4 years of experience in healthcare utilization management or a related field.
In depth understanding of regulatory and compliance requirements for drug prior authorization at both state and federal level.
Familiarity with industry standards organizations, preferably National Council for Prescription Drug Programs (NCPDP), URAC, and NCQA accreditation.
Ability to work independently and adapt quickly to changing environments.
Acts with urgency in a fast-paced environment with competing priorities.
Excellent strategic thinking and problem-solving abilities.
Process optimization and efficiency improvement
Strong analytical and decision-making skills
Previous experience developing or analyzing clinical criteria in relation to formulary management a strong plus.
Proficiency in Microsoft Office, including Excel and Access.
Strong organizational skills and ability to manage multiple projects.
Ability to work in a fast-paced environment with a sense of urgency
Ability to travel as needed up to 10%
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 116,200 - 193,600 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.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. 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) 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 HealthcareCigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. 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 require reasonable accommodation in completing the online application process, please email: [email protected] for support. Do not email [email protected] for an update on your application or to provide your resume as you will not receive a response.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.
Expected salary: $116200 - 193600 per year
Location: Saint Louis, MO
Job date: Mon, 28 Apr 2025 22:19:26 GMT
Apply for the job now!
Apply Now