Clinical Program Advisor - Express Scripts - Hybrid (Strategic Markets - Prime Therapeutics)
About The Position
The Clinical Program Advisor will be responsible for review, consultation, and clinical evaluation of utilization management criteria to align with pharmaceutical rebate contract requirements and providing quality assurance evaluations that will promote accurate rebate invoicing. This role will work cross-functionally with the Pharmaceutical Contracting, Clinical Consulting, 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. Additional responsibilities include acting as a point of contact for client’s clinical and formulary-related initiatives, completing financial/rebate impact assessments to evaluate utilization management strategies, conducting ongoing formulary maintenance and new formulary implementation reviews, and identifying prospects for clinical program adoption.
Requirements
- B.S. in Pharmacy with experience or Doctor of Pharmacy
- Current U.S. pharmacist license
- Experience in PBM, Pharmaceutical and Healthcare industry
- Experience with Pharmaceutical Contracts and Pharmacy Benefits strongly preferred
- Experience with clinical utilization criteria evaluation strongly preferred
- Excellent presentation and communication skills required
- Successfully function while handling multiple tasks and ability to prioritize
- 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
- 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.
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
- 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
- medical
- vision
- dental
- well-being and behavioral health programs
- 401(k)
- company paid life insurance
- tuition reimbursement
- a minimum of 18 days of paid time off per year
- paid holidays
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
