Clinical Program Advisor (ICOG Criteria Implementation) - Remote (Finance)

The Institute of Clinical Oversight and Guidance (ICOG) Clinical Program Advisor role is responsible for establishing, maintaining, and enhancing all best practices within the organization related to translating Clinical Policy into Branching Logic ultimately administered by the Coverage Review Organization (CRO). This encompasses criteria across all lines of business for Cigna HealthCare and includes both Pharmacy and Medical Benefit. Best practices include, but are not limited to, alignment with and support of clinical intent, business initiatives, compliance/legal requirements and corporate-driven efficiency initiatives. These established best practices serve as the foundation by which Cigna Healthcare can ensure that their policies are accurately delivered and consistently delivered as part of the coverage review process.

This role serves as a subject matter expert within the organization in support the following:

• Creation of question and answer sets which capture intent of clinical policy delivered by HTAC
• Implementing enhancements delivered by the Business Utilization Management team
• Delivering on global projects that align with dynamic business initiatives and priorities.
• Consulting and advising on branching logic/system capabilities in evaluating and implementing new product offerings/programs.
• Providing consultation and guidance on initiatives to enhance the coverage review experience for members and providers

Qualifications:

• Licensed Pharmacist required
• Bachelor's degree in Pharmacy required; PharmD preferred
• Prior Pharmacy Benefit Management (PBM) experience working with configuration of criteria desired
• Minimum of 3+ years of experience in the managed care healthcare industry required
• Understanding of prior authorization workflow and the ability to troubleshoot as needed preferred
• Excellent verbal and written communication skills required.
• Demonstrated ability to work in a highly matrixed environment
• Proven communication, interpersonal and collaboration skills
• Demonstrates strong multi-tasking skills and comfortable with managing multiple priorities
• Admin Toolkit (ATK) familiarity a plus
• Negotiation, problem solving, analyzing, and decision making skills are desirable
• Ability to deal with ambiguity. Needs to be comfortable working independently and be a self-starter.
• Must be team-oriented and possess a positive and proactive attitude which reflects a strong commitment to clinical services and company goals.

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 95,100 - 158,500 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 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.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.