Clinical Program Senior Advisor, Specialty Drug

Job Summary:

• This position supports case review for therapeutic products adjudicated through the medical benefit for the eviCore Specialty Drug program.

• Time will be spent translating clinical information from the FDA label and the pivotal Phase III trials, in collaboration with the Policy Development team. There will also be a role in reviewing and updating previously developed framework on an annual basis.

• This position requires the ability to research and interpret peer-reviewed medical and pharmacy literature to identify any potential changes supporting clinical expansion of coverage for individual therapeutic products.

• The job also includes providing clinical rationale for case review decisions during written case audits of the program.

• There will be an opportunity to collaborate with colleagues across the enterprise, including other pharmacists, Medical Directors, Program Operations, Analytics and Information Technology.

Minimum Requirements:  

• Doctor of Pharmacy (PharmD)

• Active pharmacy licensure in state of residence

• Experience in medication therapy management, managed care pharmacy or drug information  

• Advanced training in drug use management, medical/pharmacy guideline review or development, policy creation or program development

• Ability to conduct critical medical/pharmacy literature reviews, including evaluation of data

• Familiarity with pharmacy and/or medical benefit drug utilization management programs and compliance standards

• Ability to work independently while possessing effective critical thinking and decision-making skills 

• Familiarity with Microsoft Office programs, including PowerPoint and Visio

• Ability to provide Holiday and weekend coverage on a rotational basis with other team members.

Responsibilities:

• Provide timely expert clinical review of prescription medications in order to evaluate the medical necessity of services being requested.

• Document all actions related to clinical case review in the system.

• Work closely with eviCore Medical Directors to coordinate clinical reviews with the appropriate clinical experts during initial case review and appeals as needed.

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 Evernorth Health Services

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. 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 char