Sr. Clinical Consultant - Evernorth - Hybrid (Medicare)

JOB SUMMARY

The Medicare Sr. Clinical Consultant pharmacist is primarily tasked with meeting the clinical needs of the Medicare Standard Formulary and Utilization Management product offering. This position works cross-functionally with the Drug Evaluation Unit (DEU) in ICOG, the Standard Criteria Team in ICOG, the Medicare Formulary Management team, the Medicare Formulary Operations Team, Clinical Account Executives, and Legal/Compliance.

ESSENTIAL FUNCTIONS:

• Ensuring Medicare utilization management programs and criteria (prior authorization, step therapy, quantity level limits, formulary exception) are clinically sound, aligned with committee guidance, documented consistently, and compliant with regulation.
• Evaluating drug attributes to determine Medicare Part D and/or Part B coverage eligibility.
• Coordination of Medicare criteria linking requirements by Standard formulary
• Medication Therapy Management (MTM) clinical support in collaboration with vendor(s). Review standard clinical messaging and present criteria/messaging to internal clinical committees for review and approval.
• Performing quality control on Medicare criteria branching logic (i.e., criteria formatted for Coverage Review Department [CRD])
• Performing quality control on Standard Medicare drug lists to ensure alignment with clinical intent.
• Serve as a clinical support for the annual and monthly Formulary Reference File (FRF) processes.
• Communicate forthcoming UM strategy (including commercial strategies, when appropriate), Medicare criteria development, and Medicare criteria updates to the Medicare Formulary Management Team, Medicare Formulary Operations Team, and Medicare account teams.

QUALIFICATIONS:

• Doctor of Pharmacy or Registered Pharmacist
• At least 3+ years clinical pharmacy experience
• Medicare experience strongly preferred
• Excellent written communication skills with strong attention to detail
• Team-oriented with a service-oriented attitude

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 125,700 - 209,500 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 Se