Coverage Review Clinical Staff Pharmacist - Express Scripts - Remote (Finance)
This is a remote position.
During the initial training period (approximately two weeks), the work schedule will be Monday through Friday, 8:30 AM to 5:00 PM Eastern Time (EST) .
After training is complete, the regular schedule will shift to Monday through Friday, 9:30 AM to 6:00 PM in the candidate's local time zone .
Role Summary :
Utilization management pharmacists are responsible for reviewing each plans policy to determine if coverage can be granted for a medication. Provide clinical support and oversight for all utilization management (UM) activities. Responsible for finalizing all denials of clinical prior authorization requests.
Responsibilities :
- Supports the Coverage Review Department (CRD) as a clinical resource for drug therapy questions
- Applies critical thinking to achieve proper clinical decisions when performing clinical reviews
- Utilizes multiple systems and other clinical resources to achieve proper decisions in Utilization Management reviews
- Works and maneuvers within a queue system that prioritizes clinical reviews
- Makes clinical decisions quickly and at times decides and acts with limited information
- Works and collaborates with a multi-disciplinary clinical team to provide a customer centric experience
Qualifications :
- Licensed Pharmacist required
- Bachelor's Degree in Pharmacy required; PharmD preferred
- 5+ years of clinical pharmacy experience
- Proficient technical skills utilizing Microsoft Office applications required
- Utilization Management Experience Preferred, but not required
- Experience with Specialty Pharmacy/Pharmaceuticals preferred
- 2+ years lead/supervisor or retail pharmacy experience preferred
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 hourly rate of 53 - 89 USD / hourly, 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.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
