Clinical Program Advisor (ICOG Criteria Implementation) - Remote

The Institute of Clinical Oversight and Guidance (ICOG) Clinical Program Advisor role is responsible for establishing, maintaining, and enhancing all best practices within the organization related to translating Clinical Policy into Branching Logic ultimately administered by the Coverage Review Organization (CRO).

This encompasses criteria across all lines of business for Cigna HealthCare and includes both Pharmacy and Medical Benefit.

Best practices include, but are not limited to, alignment with and support of clinical intent, business initiatives, compliance/legal requirements and corporate-driven efficiency initiatives.

These established best practices serve as the foundation by which Cigna Healthcare can ensure that their policies are accurately delivered and consistently delivered as part of the coverage review process.

This role serves as a subject matter expert within the organization in support the following:


* Creation of question and answer sets which capture intent of clinical policy delivered by HTAC


* Implementing enhancements delivered by the Business Utilization Management team


* Delivering on global projects that align with dynamic business initiatives and priorities.


* Consulting and advising on branching logic/system capabilities in evaluating and implementing new product offerings/programs.


* Providing consultation and guidance on initiatives to enhance the coverage review experience for members and providers

Qualifications:


* Licensed Pharmacist required


* Bachelor's degree in Pharmacy required; PharmD preferred


* Prior Pharmacy Benefit Management (PBM) experience working with configuration of criteria desired


* Minimum of 3+ years of experience in the managed care healthcare industry required


* Understanding of prior authorization workflow and the ability to troubleshoot as needed preferred


* Excellent verbal and written communication skills required.


* Demonstrated ability to work in a highly matrixed environment


* Proven communication, interpersonal and collaboration skills


* Demonstrates strong multi-tasking skills and comfortable with managing multiple priorities


* Admin Toolkit (ATK) familiarity a plus


* Negotiation, problem solving, analyzing, and decision making skills are desirable


* Ability to deal with ambiguity.

Needs to be comfortable working independently and be a self-starter.


* Must be team-oriented and possess a positive and proactive attitude which reflects a strong commitment to clinical services and company goals.

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.

For this position, we anticipate offering an annual salary of 95,100 - 158,500 USD / yearly, depending on relevant factors, including experience and geographic location.

This role i...