• Job Description

  Req#: 23013506

  Overview:

  This position will be responsible for review and interpret rules of client benefit utilization management programs and impacts on 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.

  Responsibilities:

  • 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 FRP 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.
  • Evaluate client benefit programs for recommendations that drive increased value for the client and organization.
  • Other duties as assigned.

  Qualifications:

  • 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.

  
  

  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 109,500 - 182,500 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 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 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.

• About the company

  Cigna is an American worldwide health services organization based in Bloomfield, Connecticut.

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