Clinical Program Senior Manager - Hybrid (Multiple Locations)
About the position
The Clinical Program Senior Manager is responsible for overseeing the implementation activities related to formulary management and utilization management within the pharmacy and medical benefits. This role is crucial in ensuring that affordability targets are met, compliance with regulatory requirements is maintained, and the business strategy is effectively executed. The position encompasses a variety of activities aimed at enhancing affordability solutions, including utilization management edits at the point of service, preferred drug list strategy, retrospective utilization review, risk management review, and condition-specific interventions. The Senior Manager will collaborate closely with various matrix partners across the medical organization, including Pharmacy Benefit Managers (PBM), Contracting, Pharmacy pricing/finance, Clinical Operations, Coverage Policy Unit, and others to ensure a cohesive approach to formulary management. In this role, the Senior Manager will lead a team of clinical pharmacists who are integral to supporting formulary management activities. Responsibilities include executing implementation strategies for major specialty and non-specialty drug classes, evaluating the success of current utilization management programs, and monitoring market share leakage for non-formulary drugs. The Senior Manager will also provide education and training for clinical teams to ensure consistent execution of clinical strategies and actions. Oversight of the review and audit processes for Health Plan Value Assessment Committee recommendations is also a key responsibility, ensuring compliance with P&T guidelines and state and federal regulations. Additionally, the Senior Manager will be responsible for post-implementation affordability monitoring, oversight of the new drug management process, and engaging with matrix partners to identify potential impacts to formulary strategies. This hybrid position allows for flexibility in work location, requiring three days in the office and two days working from home, with the expectation that the candidate can be based out of any US Cigna Healthcare office.
Responsibilities
Lead a team of clinical pharmacists with day-to-day formulary management activities
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Execute implementation strategies for major specialty and non-specialty drug classes across the pharmacy and medical benefit
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Evaluate the success of current utilization management programs to determine areas of enhancement
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Monitor market share leakage for non-formulary drugs and implement strategies to address leakage and waste in the commercial population
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Provide education and training for clinical teams to communicate clinical strategy and actions
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Oversee the review and audit of all Health Plan Value Assessment Committee recommendations/decisions
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Ensure compliance with P&T guidelines for formularies
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Oversee all state audits and updated regulatory requirements
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Monitor post-implementation affordability related to clinical issues
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Oversee the new drug management process for pharmacy and medical drugs
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Support the oversight of clinical research tasks to support formulary strategy leads
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Engage with matrix partners to identify potential impacts to formulary strategies
Requirements
PharmD preferred
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Licensed Pharmacist required
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Previous management experience required
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Experience with formulary/utilization management implementation activities in a PBM and/or HealthPlan environment required
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Minimum of 4 years Clinical Pharmacy experience required, preferably in a Pharmacy Benefit Management (PBM) and/or Health Plan
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Proven capabilities in strategic planning and auditing
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Solid understanding of evidence-based medicine and interpreting clinical literature
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Demonstrated ability to work in a highly matrixed environment
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Demonstrated ability to present to and engage with senior leaders
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Results driven with proven communication, interpersonal and collaboration skills
Nice-to-haves
Benefits
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