Clinical Pharmacist (Cigna Medicare) - Utilization Management at Cigna in Memphis, Tennessee

Posted in General Business 12 days ago.

Type: Full-Time





Job Description:

Position Title: Clinical Pharmacist - Utilization Management Department: Drugs/Biologics Part B

Reports To: Clinical Program Senior Manager

Exemption Status: Exempt

Role Summary: The Clinical Pharmacist supports the execution of Cigna Medicare advantage clinical programs. The Clinical Pharmacist assists with the development of Drugs/Biologics Part B initiatives that ensure appropriate utilization. Our goal is to manage Drug/Biologic Part B utilization while maintaining and enhancing our relationships with Cigna Medicare Advantage providers and customers.

Essential Duties and Responsibilities:

• Reviews and completes coverage requests for Drugs/Biologics Part B according to applicable coverage policies and regulatory compliance requirements.

• Provides information to providers and members, including but not limited to coverage criteria and Medicare Part B benefit.

• Develops Drug/Biologic Part B specific precertification forms and denial rationales based on coverage criteria and Medicare Part B benefit.

• Coordinates cases with other clinical teams that support Cigna Medicare advantage clinical programs.

• Provides guidance to intake representatives on processing coverage requests.

• Completes assigned projects related to Drugs/Biologics Part B clinical programs.

• Other duties as assigned by management.

Qualifications:

• Pharmacy Degree (Pharm. D) or equivalent

• Licensed Pharmacist required

• 2+ years practicing Pharmacy experience with strong clinical skills

• 2+ years of direct Medicare coverage review/utilization management experience preferred

• Pharmacy Residency or Board Certification preferred (i.e. Board Certified Pharmacotherapy Specialist (BCPS) o Knowledge of Microsoft Office Suite Word and Excel software and the ability to quickly learn proprietary systems

• Ability to adapt to changing environments and processes o Strong organization and planning skills

• Team oriented with strong verbal and written communication skills

• Work Schedule: Day and evening hours Monday thru Friday with rotating weekends

  • Must be willing to work on PST

This position is not eligible to be performed in Colorado.

About Cigna

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. What difference will you make?

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: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.





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