Clinical Senior Advisor - Express Scripts - Hybrid (Commercial Formulary Solutions)

This is a Hybrid position (3 days per week in-office + 2 days work at home). The incumbent candidate can be based out of any US Cigna Healthcare office and is not restricted to locations that are listed in this posting.

Position Overview

The Clinical Senior Advisor plays a pivotal role within the Commercial Formulary Solutions (CFS) team, providing expert guidance on formulary management and regulatory compliance. This position ensures that formulary strategies align with the Affordable Care Act (ACA), Essential Health Benefit (EHB) requirements, and anti-discriminatory drug coverage regulations. The Clinical Senior Advisor facilitates communication between internal teams, regulatory agencies, and clients, ensuring optimal drug coverage, regulatory adherence, and stakeholder education.

Key Duties and Responsibilities

• Formulary Management Consultative Support: Collaborate with the CFS formulary management team to develop, review, and update commercial formularies to ensure drug coverage within the ESI standard formularies are compliant in all states in the US Marketplace.
• Value Assessment Committee consultation and participation: Actively participate in review of materials as needed in preparation for the VAC meetings, providing clinical Marketplace expertise and consultation.
• ACA Compliance Oversight: Ensure formularies and drug coverage programs comply with ACA mandates, including coverage for Preventive Items and Services and adherence to non-discrimination standards.
• Essential Health Benefit Management: Oversee the integration and maintenance of EHB requirements within all applicable formularies, guaranteeing comprehensive consultation for compliant drug coverage.
• Preventive Coverage Administration: Monitor and consult on Preventive Items and Services coverage requirements to support clients in ensuring alignment with current regulatory guidance and best practices.
• Anti-Discrimination Regulation Adherence: Maintain awareness of anti-discriminatory drug coverage regulations and advise clients on necessary changes to maintain compliance across formularies.
• Regulatory Collaboration: Work closely with the Regulated Markets team to monitor and incorporate federal and state regulatory updates into formulary strategies and documentation.
• RFP Inquiry Response Support: Address Requests for Proposal (RFP) inquiries related to Marketplace formulary management, regulatory compliance, and drug coverage, providing clear and accurate information to support business development.
• Client Consultation: Serve as a clinical consultant to ESI Qualified Health Plan (QHP) clients, offering expertise on formulary structure, drug coverage submissions, and regulatory requirements.
• Client specific consultation and preparation of submission forms and formulary file templates.
• Collaboration and Communication: Partner with the Health Plan Division, Clinical Operations, and Regulated Markets teams to ensure consistent application of formulary policies and regulatory guidance.
• Liaise with external stakeholders, including clients and regulatory bodies, to communicate formulary strategies, regulatory updates, and program enhancements.
• Regulatory Compliance: Monitor evolving ACA, EHB, and anti-discrimination regulations, proactively consulting on formulary updates and processes to maintain full compliance.
• Document and report on compliance initiatives and outcomes for internal and external audit purposes.
• Training and Support: Develop and deliver training materials and sessions for internal clients (i.e., Health Plan Division and Clinical Operations staff) on formulary management, regulatory changes, and compliance best practices.
• Actively participate in a variety of Formulary Solutions ad hoc activities.
• Provide ongoing support and education for internal teams and external clients regarding formulary updates, competitive landscape, regulatory changes, and coverage requirements.

Qualifications and Skills

• Advanced clinical degree (PharmD, B.S. Pharmacy, or equivalent) required.
• Minimum of 5 years’ experience in formulary management, pharmacy benefit management, or a related healthcare field. Preferable, but not required, is experience with the Marketplace line of business including knowledge of ACA, EHB, and anti-discrimination drug coverage regulations.
• Ability to interpret and apply federal and state regulatory guidance to formulary structures.
• Strong analytical, organizational, and communication skills.
• Experience collaborating with cross-functional teams and external clients.
• Demonstrated ability to develop and lead training initiatives.

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.

At The Cigna Group, 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), 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, click here.

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.