Clinical Senior Advisor - Express Scripts - Hybrid (Commercial Formulary Solutions)

The Cigna Group • St. Louis, MO

5h • Hybrid

About The Position

The Clinical Senior Advisor plays a pivotal role within the Commercial Formulary Solutions (CFS) team, providing expert guidance on formulary management and regulatory compliance. This position ensures that formulary strategies align with the Affordable Care Act (ACA), Essential Health Benefit (EHB) requirements, and anti-discriminatory drug coverage regulations. The Clinical Senior Advisor facilitates communication between internal teams, regulatory agencies, and clients, ensuring optimal drug coverage, regulatory adherence, and stakeholder education.

Requirements

• Advanced clinical degree (PharmD, B.S. Pharmacy, or equivalent) required.
• Minimum of 5 years’ experience in formulary management, pharmacy benefit management, or a related healthcare field.
• Ability to interpret and apply federal and state regulatory guidance to formulary structures.
• Strong analytical, organizational, and communication skills.
• Experience collaborating with cross-functional teams and external clients.
• Demonstrated ability to develop and lead training initiatives.
• 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.

Nice To Haves

• Preferable, but not required, is experience with the Marketplace line of business including knowledge of ACA, EHB, and anti-discrimination drug coverage regulations.

Responsibilities

• Formulary Management Consultative Support: Collaborate with the CFS formulary management team to develop, review, and update commercial formularies to ensure drug coverage within the ESI standard formularies are compliant in all states in the US Marketplace.
• Value Assessment Committee consultation and participation: Actively participate in review of materials as needed in preparation for the VAC meetings, providing clinical Marketplace expertise and consultation.
• ACA Compliance Oversight: Ensure formularies and drug coverage programs comply with ACA mandates, including coverage for Preventive Items and Services and adherence to non-discrimination standards.
• Essential Health Benefit Management: Oversee the integration and maintenance of EHB requirements within all applicable formularies, guaranteeing comprehensive consultation for compliant drug coverage.
• Preventive Coverage Administration: Monitor and consult on Preventive Items and Services coverage requirements to support clients in ensuring alignment with current regulatory guidance and best practices.
• Anti-Discrimination Regulation Adherence: Maintain awareness of anti-discriminatory drug coverage regulations and advise clients on necessary changes to maintain compliance across formularies.
• Regulatory Collaboration: Work closely with the Regulated Markets team to monitor and incorporate federal and state regulatory updates into formulary strategies and documentation.
• RFP Inquiry Response Support: Address Requests for Proposal (RFP) inquiries related to Marketplace formulary management, regulatory compliance, and drug coverage, providing clear and accurate information to support business development.
• Client Consultation: Serve as a clinical consultant to ESI Qualified Health Plan (QHP) clients, offering expertise on formulary structure, drug coverage submissions, and regulatory requirements.
• Client specific consultation and preparation of submission forms and formulary file templates.
• Collaboration and Communication: Partner with the Health Plan Division, Clinical Operations, and Regulated Markets teams to ensure consistent application of formulary policies and regulatory guidance.
• Liaise with external stakeholders, including clients and regulatory bodies, to communicate formulary strategies, regulatory updates, and program enhancements.
• Regulatory Compliance: Monitor evolving ACA, EHB, and anti-discrimination regulations, proactively consulting on formulary updates and processes to maintain full compliance.
• Document and report on compliance initiatives and outcomes for internal and external audit purposes.
• Training and Support: Develop and deliver training materials and sessions for internal clients (i.e., Health Plan Division and Clinical Operations staff) on formulary management, regulatory changes, and compliance best practices.
• Actively participate in a variety of Formulary Solutions ad hoc activities.
• Provide ongoing support and education for internal teams and external clients regarding formulary updates, competitive landscape, regulatory changes, and coverage requirements.

Benefits

• 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 and paid holidays.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Ph.D. or professional degree