Posted in General Business 30+ days ago.
Type: Full-Time
Position Summary:
The Senior Clinical Consultant pharmacist is primarily tasked with meeting the clinical needs of both the commercial and Regulated Markets' product offerings and initiatives. Those responsibilities include, but are not limited to, ensuring that utilization management programs and criteria (prior authorization, step therapy, quantity level limits, non-formulary exception), medication therapy management (MTM) programs and criteria, and Affordable Care Act-mandated programs and criteria are medically appropriate and compliant. This role also works to 1) ensure that criteria written as branching logic for the Coverage Review Department (CRD) to administer is aligned with clinical policy intent and CRD system capabilities and enhancements and 2) develop and coordinate consistent reporting to lead quality assurance initiatives associated with branching logic. Finally, this position coordinates in a cross-functional manner with the other clinical groups that make up the Office of Clinical Evaluation & Policy (OCEP), product management, account management, formulary management, government affairs, compliance, and operations.
Essential Functions:
1. Develop and maintain criteria in all formats necessary. Ensure that the criteria are clinically justifiable, P&T approved, and administered in a manner that is consistent with the clinical program intent, including branching logic quality assurance.
2. Create, maintain, and support clinical solutions that driven by both Commercial and Regulated Market Product teams.
Qualifications:
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.
About The Cigna Group
Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we're dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. 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: 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.
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.
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