Clinical Program Advisor – Clinical Operations
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Job Description
Clinical pharmacy advisor guiding Medicare benefit programs for Evernorth, which creates pharmacy, care, and benefit solutions. Advising clients, sales teams, and internal stakeholders on clinical operations and implementation.
Responsibilities:
- Provide counsel and advice to top management on significant Clinical Program Management matters
- Provide thought leadership and technical expertise across multiple disciplines
- Coordinate across organizations and represent the company externally
- Educate and enable care coordination between stakeholders to optimize healthcare experience and customer satisfaction
- Serve as clinical advisor to the sales organization with product and industry knowledge/education
- Serve as business owner for client work involving Medicare operational and implementation benefits changes
- Understand clients’ clinical benefits and business philosophies
- Capture and document clinical benefit requirements with business stakeholders
- Provide customer service and act as a trusted client advisor
- Partner internally to vet, understand, and communicate implications of clinical benefit requirements
- Provide operational subject matter expertise to clinical, implementation, benefit administration, application, and product teams
- Manage and track requests to ensure timelines are met
- Develop deep understanding of claims adjudication systems and associated clinical applications
- Lead development, preparation, and presentation of project plans, including execution and delivery
- Participate in and contribute to training and professional development activities
- Provide project and administrative support and escalate issues, risks, and concerns
Requirements:
- Current U.S. Pharmacist License
- Pharm.D.
- Minimum of 3 years licensure experience preferred in managed care or with previous PBM experience
- Knowledge of PBM industry, managed care, or value-based healthcare industry is desirable
- Microsoft Office, with strong understanding of Excel and Access
- Ability to multitask and communicate effectively
- Written and verbal communication skills, including listening, feedback, and translating complex ideas/processes
- Collaboration, analytical/critical thinking, results-oriented, and organizational skills
- Ability to manage multiple tasks, prioritize, resolve complex issues, and apply strong project management skills
- Ability to learn internal reporting and analytic tools
- Ability to manage timelines and meet tight client deadlines
- Advanced problem-solving skills
- Ability to work collaboratively across departments
- Ability to work under pressure and perform continual follow-up
- Home internet through cable broadband or fiber optic service with at least 10 Mbps download and 5 Mbps upload
- Must be eligible to work in the United States
Benefits:
- Annual bonus plan eligibility
- Medical insurance
- Vision insurance
- Dental insurance
- Well-being and behavioral health programs
- 401(k)
- Company-paid life insurance
- Tuition reimbursement
- Minimum of 18 days of paid time off per year
- Paid holidays
- Leaves of absence
- Remote work arrangement
- Cable broadband or fiber optic internet requirement for home working
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