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Clinical Program Senior Advisor, Rebate Optimization - Express Scripts

Job typeFull Time
CountryUnited States

This position will be responsible for review and interpretation of over 120,000 current clinical rules impacting rebate eligible drugs. Review and interpret for rebate impact over 160 custom formularies for approximately 20 externally adjudicated clients. Continuously review changes, additions and deletions to client clinical rules impacting rebate eligible dugs estimated to be over 150,000 changes annually. Annual rebates impacted by this analysis is approximately $7-9 Billion.

• Evaluate Client clinical rules and policies for Manufacturer Rebate eligibility. Ensuring assessment is timely and accurate. Ensure client eligibility is appropriately assigned and submission to FRP rebate system is in proper format for invoicing.
• Work cross-functionally with Pharma Contracting, Clinical Account Executives and Pharma Invoicing to ensure appropriate interpretation of clinical rules and impacts on rebated drug products.
• Consolidate clinical rules with impacts to rebate drug products to a single list of assigned ids for upload and utilization within the FRS rebate system, where applicable.
• Develop and document appropriate policy and procedures for analysis and appropriate determination of client eligibility for rebate enhancement and exclusion options. Continually update documents as processes change and review at a minimum on an annual basis.
• Work with externally adjudicated clients to assess custom formulary rules not housed within Express Scripts systems for determination of rebate eligibility. Work as a liaison in support of these clients to assist in appropriate benefit decisions to maximize rebate opportunities.
• Evaluate all Express Scripts clients, both full service and externally adjudicated, on an annual basis to determine level of control designation: open, controlled, closed. Prepare appropriate documentation for loading to FRP rebate system. Evaluate new clients throughout the year for determination of level of control and assure appropriately relayed to FRP system.
• Other duties as assigned:

• B.S. Pharmacy or PharmD
• 2-4 years of benefit analysis in PBM industry. CAE or CPM experience a major plus
• Pharmacist License required
• Excellent PC skills including Microsoft Office with a high degree of proficiency in Access and Excel required. Familiarity with SQL would be considered a strong plus.
• Excellent problem solving and communication skills required. Must be able to work under pressure and perform continual follow up in a timely manner in order to meet tight deadlines.

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.
Employer187 Express Scripts Services Co