Senior Advisor, Pharmacy UM Strategy & Operations - Cigna Healthcare - Hybrid
About The Position
The job profile for this position is Clinical Program Senior Advisor, which is a Band 4 Senior Contributor Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply! Our people make all the difference in our success. The Business Project Senior Advisor will report to the Cigna Pharmacy Business UM Operationalization team and play a critical role in leading and supporting high-profile initiatives and complex issue resolution. This role requires deep expertise in pharmacy and medical claims, prior authorization (PA) and utilization management (UM) operations, and benefit configuration. The position serves as a CHC health plan subject matter expert (SME), ensuring formulary strategy intent, operational feasibility, compliance and contract guardrails, and downstream member and provider impacts are fully considered—particularly within enterprise initiatives where PBM or medical-forward assumptions may not account for pharmacy versus medical benefit complexity.
Requirements
- Bachelor’s degree preferred, or 10+ years of relevant drug prior authorization experience.
- Extensive knowledge of pharmacy and medical benefit UM operations and claims processing.
- Strong analytical skills with experience working with large datasets.
- Proven ability to lead complex initiatives and influence across matrixed teams.
- Clear, concise communication skills with the ability to present to senior leadership.
Responsibilities
- Lead and/or support high-visibility business projects impacting CHC drug UM operations, ensuring CHC health plan needs are represented throughout design, build, testing, and implementation.
- Serve as an SME on UM systems and operational workflows, including authorization behavior under both pharmacy and medical benefits and downstream impacts to operations and communications.
- Investigate complex escalations by validating true root cause using claims and benefit configuration data and UM operational knowledge; distinguish perceived issues from defects, configuration gaps, or process breakdowns.
- Analyze and interpret large datasets (claims, benefit files, UM outcomes) to quantify impact, identify patterns, and recommend sustainable end-to-end solutions.
- Translate business strategy and compliance or contract requirements into clear operational requirements and guardrails for cross-functional partners (operations, technology, and build teams).
- Present solution options with risks, benefits, and tradeoffs related to patient and prescriber experience, affordability, compliance exposure, and operational feasibility; provide clear recommendations to leadership.
- Support AHIP-related drug benefit and UM initiatives, including problem-solving for fallout scenarios and process gaps.
- Drive communication in a highly matrixed environment with exposure to senior leadership; keep leadership informed and escalate risks or roadblocks as needed.
- Perform other duties as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
