Clinical Staff Pharmacist – Express Scripts Coverage Review Department (CRD)

Training Schedule: 9AM-5:30PM EST for approximately 4 weeks

Schedule after Training: 9:30AM-6PM local time zone

Role Summary:

Utilization management pharmacists are responsible for reviewing each plans policy to determine if coverage can be granted for a medication. Provide clinical support and oversight for all utilization management (UM) activities. Responsible for finalizing all denials of clinical prior authorization requests.

Responsibilities:

• Supports the Coverage Review Department (CRD) as a clinical resource for drug therapy questions

• Applies critical thinking to achieve proper clinical decisions when performing clinical reviews

• Utilizes multiple systems and other clinical resources to achieve proper decisions in Utilization Management reviews

• Works and maneuvers within a queue system that prioritizes clinical reviews

• Makes clinical decisions quickly and at times decides and acts with limited information

• Works and collaborates with a multi-disciplinary clinical team to provide a customer centric experience

Qualifications:

• Licensed Pharmacist required

• Bachelor’s Degree in Pharmacy required; PharmD preferred

• 5+ years of clinical pharmacy experience

• Proficient technical skills utilizing Microsoft Office applications required

• Utilization Management Experience Preferred, but not required

• Experience with Specialty Pharmacy/Pharmaceuticals preferred

• 2+ years lead/supervisor or retail pharmacy experience preferred

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 hourly rate of 55 - 91 USD / hourly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. 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, paid holidays, and leaves of absence. For more details on our employee benefits programs, .