Clinical Program Manager

Description:
1.May work with and support sales force.
Continually review and assess Medicare Part D regulations and CMS guidance and develop CIGNA clinical program strategy to assure CIGNA meets all relevant regulations.
2.Design and develop Medicare Part D clinical program strategy component of overall corporate and pharmacy clinical program strategy.
3.Achieve Medicare Part D pharmacy cost management PMPM and Low Net Cost goals as determined by Part D strategy.
4.Manage MTMP clinical unit of pharmacists and pharmacy technicians to meet established clinical and service goals.
5.Coordinate with Policy and Formulary Management department to assure consistent strategy and operational workflows
6.Develop Medication Therapy Management content, infrastructure and reporting process.
7.Serve as market Part D clinical subject matter expert for internal and external presentations.
8.Develop Part D specific pharmacy utilization management programs such as prior authorization, quantity, therapy over time, prerequisite/preclusive edits. Develop and implement low cost alternative program for therapeutically equivalent drug products, incorporating step therapy and quantity limitations as appropriate. Develop and apply prior authorization programs for medical necessity as identified
9.Develop and maintain appropriate clinical, evidence-based documentation that supports all senior and Part D related clinical programs.
10.In association with marketing, develop supporting materials that highlight competencies in cost and clinical management for the Part D segment.

Oversees and directs the development, evaluation and implementation of new or changing health care programs and medical services for the organization.
Reviews clinical and administrative techniques associated with health plan management, medical trends, case management, utilization management, and medical management.
Works with IT and Product organizations to implement programs.

Qualifications:
Licensed pharmacist
Degree in pharmacy practice, advanced clinical degree (PharmD or clinically-oriented masters degree) required
3-5 years experience in clinical practice
Medicare/Medicaid clinical program development experience preferred
Strong communication skills required
Bloomfield, CT location preferred.

Salary/Benefits: Salary commensurate with experience
CIGNA offers a competitive compensation and comprehensive benefits package including health and wellness benefits, 401k plan, and work/life balance programs, as well as opportunities for career growth and development.

Job Location: BLOOMFIELD, CT

Job Number: 43383

Company URL: http://www.CIGNA.com

Company Profile:
At CIGNA, we are committed to providing our customers with employee benefits, expertise and services that improve the health, well-being and productivity of their employees. CIGNA's people are the key to our success in a changing and increasingly competitive marketplace. The collective skills, behaviors and work experiences of all CIGNA employees enable us to make a real difference in the lives of our members. We seek the most talented and creative minds in the industry to develop innovative solutions our customers value and consumers expect.