This position will support creation of a clinical data elements library. The data elements library will be derived from our existing, standard prior authorization policies.
Clinical Specialists are responsible for strategic development, creation, and maintenance of standard clinical products and services within their assigned product areas. Clinical Specialists clinically frame new solutions to ensure alignment with existing guidance and consistency across products and services throughout the organization. They also guide and manage the clinical enhancement of existing products, working closely with cross-functional partners to ensure final solutions are clinically sound, defensible, and aligned with organizational standards. In addition, Clinical specialists work collaboratively with product managers, and our sales and account teams to ensure that our clinical recommendations and program offerings are not only clinically appropriate but meet the business needs of our internal and external customers.
ESSENTIAL FUNCTIONS:
The primary function of this role is to develop and maintain drug lists related to state mandates. Drive recommendations through necessary legal, regulatory and clinical governing bodies.
Facilitate cross-functional collaboration with regulated markets, legal, clinical and account management clinical leadership
Clinically frame new solutions that are congruent with existing guidance to ensure products & services across the organization are clinically aligned.
Frame, guide, and manage the clinical enhancement of existing products with cross-functional partners to ensure the final solution is clinically sound and defendable.
Translate clinical treatment guidelines, medical literature and prescribing information into population health & safety alerts for providers, pharmacists, and members.
Other activities as needed including meeting with pharmaceutical manufacturers to gather clinical information; review, prepare, and support clinical content for other clinical programs.
Must be team-oriented and possess a proactive and optimistic style which reflects a strong commitment to clinical services and company goals.
MINIMUM QUALIFICATIONS:
BS in Pharmacy or Doctor of Pharmacy (Pharm.D.) degree required
Relevant managed care experience
Active Pharmacist License required
Completion of a pharmacy residency preferred
Board of Pharmaceutical Specialties certification preferred
Strong written and verbal presentation skills, with the ability to communicate complex information clearly
Ability to collaborate with cross functional partners
Ability to apply clinical information to population management strategies
Strong computer skills
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.
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 need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.
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.
The Cigna Group is a global health company committed to creating a better future built on the vitality of every individual and every community. We relentlessly challenge ourselves to partner and innovate solutions for better health.
The Cigna Group includes products and services marketed under Cigna Healthcare, Evernorth Health Services or its subsidiaries. The Cigna Group maintains sales capabilities in more than 30 countries and jurisdictions, and has more than 190 million customer relationships around the world.
