Clinical Program Advisor - Express Scripts - Hybrid (Strategic Markets)

Express Scripts • Saint Louis, MO

209d • $95,100 - $158,500 • Hybrid

About The Position

This role requires the combination of a strong clinical background, deep understanding of utilization management criteria, and ability to read pharmaceutical contracts, along with business acumen and financial analytical skills to identify and execute upon strategic opportunities that align with clinical/financial objectives. The Clinical Program Advisor, Strategic Markets is responsible for assessing formulary positioning alongside applicable utilization management policies to determine client eligibility for rebates, ultimately providing quality assurance evaluations that will promote accurate rebate invoicing. This role will work cross-functionally with the Pharmaceutical Contracting, Clinical Consulting, Clinical Account Executive, and Pharmaceutical Invoicing teams to ensure formulary tier and clinical rules are interpreted correctly and will evaluate benefit set up impacts on rebated drug products. Reporting to the Clinical Program Director, this position provides clinical support in documenting formulary placement/positioning and utilization management policies and procedures for the analysis and appropriate determination of client eligibility for rebate enhancement and exclusion options. Additionally, this role offers consultative clinical support in the interpretation of rebate requirements contained within manufacturer rebate agreements, as well as advice regarding impact assessments following any proposed or implemented changes to formulary tiers, contracts, or management policies.

Requirements

• B.S. in Pharmacy with experience or Doctor of Pharmacy
• Current U.S. pharmacist license
• Experience in PBM, Pharmaceutical and Healthcare industry
• Excellent presentation and communication skills required
• Detail-oriented with strong organizational skills
• Ability to adapt in a dynamic work environment and learn quickly, solve problems, and make decisions with minimal assistance or direction from leader when interfacing with clients and other internal partners
• Ability to work independently and prioritize work to meet client needs
• Proficiency in Microsoft Office applications required

Nice To Haves

• General knowledge of Medicare and/or Medicaid pharmacy benefits
• Experience with Pharmaceutical Contracts and Pharmacy Benefits strongly preferred
• Experience with clinical utilization criteria evaluation strongly preferred

Responsibilities

• Support client with formulary, rebate, and utilization management strategies to service all current and future needs
• Participate in Clinical Program team functions, including maintaining formulary status changes for all actively maintained formularies, assessing utilization management policy updates, and consulting on anticipated clinical and financial impacts of strategies under consideration by the client
• Develop, prepare, and present clinical business strategies (formulary, utilization and/or health management strategy, support for client P&T and Business Committee meetings)
• Keep abreast with industry pipelines, such as new drugs, patent expirations, generic and biosimilar approvals and launch dates, etc.
• Act in concert with internal teams, such as Account Management to service all needs of the client
• Participate in developing tools and trainings for carrying out work plan goals, including continuous process improvement activities
• Represent the strategic market division as a point of contact for various corporate clinical initiatives, including participation in client meetings

Benefits

• Comprehensive health-related benefits including medical, vision, dental, and well-being and behavioral health programs
• 401(k) with company match
• Company paid life insurance
• Tuition reimbursement
• Minimum of 18 days of paid time off per year
• Paid holidays

What This Job Offers

• Industry: Ambulatory Health Care Services
• Education Level: Bachelor's degree