Clinical Staff Pharmacist - Coverage Review - Remote

Clinical Staff Pharmacist – Express Scripts Coverage Review Department (CRD)

Training Schedule: 9AM-5:30PM EST for approximately 4 weeks

Schedule after Training: 9:30AM-6PM 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 55 - 91 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.

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, paid holidays, and leaves of absence. For more details on our employee benefits programs, click here.

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 [email protected] 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.