The Cigna Group is hiring a Clinical Program Advisor to join Express Scripts in a remote clinical configuration role. You will serve as the business owner for clinical benefit-related IT projects, translating client requirements into accurate configuration within the F14 adjudication system to ensure implementation matches client intent.
What You'll Do
- Work with internal partners to vet, understand, and communicate implications of clinical benefit requirements.
- Translate client intent into accurate F14 system configuration in a timely manner.
- Track and communicate status of service requests.
- Assist in remediating process gaps and documenting best practices.
- Meet with clients to discuss and clarify clinical benefit requirements.
- Advise clients on the most efficient way to implement intent within F14 systems.
- Analyze new requirements against existing setup and identify interdependent impacted areas.
- Consult with team members, SMEs, and specialized teams as necessary.
- Provide clinical interpretation and guidance to team members.
- Translate requirements into internal requests/submissions and route them appropriately.
- Serve as business owner for IT projects involving clinical benefit.
- Manage and track all requests to ensure timelines and performance guarantees are met.
- Communicate completed benefit notifications to clients with documentation.
- Complete random reviews of work completed by coding teams.
- Periodically monitor claims to ensure benefit coding matches client intent.
- Develop a deep understanding of the claims adjudication system and clinical applications.
- Identify and help remediate process gaps and develop best practices/SOPs.
What We're Looking For
- Bachelor of Science in Pharmacy.
- Current U.S. Pharmacist License.
- Current RPh Licensure in good standing as required by the state in which work is performed.
- Proficiency in Microsoft Office with a strong understanding of Excel and Access.
- Written and verbal communication, collaboration, analytical/critical thinking, results-oriented, and organizational skills.
- In-depth understanding of F14 adjudication system and associated clinical applications.
- In-depth understanding of operations organizational structure and roles of departments involved with clinical requests.
Nice to Have
- Doctor of Pharmacy (PharmD) and advanced degrees or pharmacy residency.
- Minimum 3 years of licensure recommended.
Technical Stack
- Microsoft Office
- Excel
- Access
- F14 adjudication system
Team & Environment
Part of the Client Services department, which includes Client and Benefit Administration, Manual Claims Processing, Eligibility, Quality Control, Implementation, and the Client Service Center.
Benefits & Compensation
- Compensation: $120,000 - $200,000 USD yearly.
- Comprehensive health benefits including medical, vision, dental, and well-being/behavioral health programs starting day one.
- 401(k).
- Company-paid life insurance.
- Tuition reimbursement.
- Minimum of 18 days of paid time off per year plus paid holidays.
- Eligibility to participate in an annual bonus plan.
Work Mode
This is a remote position.
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.
