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Pharmacist Criteria Team Manager - Hybrid

  • ... Philadelphia, Pennsylvania, United States
  • ... Full time
  • ... Salary: 172100 per year
  • Posted on: Feb 01, 2024       Expires on:

Pharmacist Criteria Team Manager - Hybrid   

JOB TITLE:

Pharmacist Criteria Team Manager - Hybrid

JOB TYPE:

Full-time

JOB LOCATION:

Philadelphia Pennsylvania United States

JOB DESCRIPTION:

ROLE SUMMARY:


This position is responsible for managing the Cigna Clinical Operations Criteria team that ensures drug coverage policy (criteria) intent is implemented on time with consistency and accuracy across Cigna's UM intake tool(s).
The position works closely with matrix partners across clinical product, Medical Management, Express Scripts, Coverage Policy Unit and the Cigna Coverage Review Department to oversee the gathering and implementation of drug criteria intent.
The role also is responsible for working with technical and business leads for strategic planning, development, and deployment of enterprise initiatives related to drug criteria implementation (intent gathering and installation) management.


RESPONSIBILITIES:


  • Manage a small to mid-size team of production pharmacists and analysts who are responsible for timely and accurate drug criteria implementation within the UM intake tool(s) through systems, workflows, and processes.




  • Oversight of Cigna Clinical Operations Criteria implementation throughout the process




  • Identify, implement, and champion lessons learned and process improvements for the team driving change when and where needed.




  • Responsible for overseeing all drug criteria implementation processes and activities partnering with all levels of management, teams, and employees.




  • Owns the overall workflow management for criteria implementation tasks associated with changes to the drug coverage policies.




  • Partners with matrix partners to coordinate reporting and quality assurance activities to ensure implementation within the operating systems accurately meets the business intent.




  • Responsible for managing, creating and maintaining implementation team job aids, SOPs, and tools.




  • Ensures that drug criteria implementation issues are escalated to the appropriate area.




  • Develops strategic plan for team.




  • Responsible for working with technical and business leads for the development and maintenance of criteria implementation management.




  • Responsible for working with Enterprise projects that impact criteria implementation management.




  • Owns the deployment and enablement of enterprise activities associated with implementation.




QUALIFICATIONS:


Required:


  • Licensed Pharmacist




  • Bachelors degree in pharmacy (required); PharmD (preferred)




  • Ability to operate independently.




  • Proven ability to organize, hold others accountable, and manage timelines.




  • Highly experienced with negotiation, problem solving, analyzing, and decision making.




  • Proven communication, interpersonal and collaboration skills




  • Ability to operate in an ambiguous operations environment.




  • Demonstrated ability to work in a highly matrixed environment.




  • Skilled with operating and managing through an organization.




  • Highly skilled in MS Excel and advanced proficiency in MS Office.




  • Seasoned presentation skills and comfortable in front of diverse audiences.




Preferred:


  • Experience in managing small to mid-sized teams.




  • Excellent at teaching, motivating, inspiring, and developing employees.




  • Proven ability to engage a team and drive a results-focused team atmosphere.




  • Prior Pharmacy Benefit Management (PBM) experience working with criteria implementation.




  • First Data Bank experience




  • Minimum of 7-10 years experience in the healthcare industry




  • 5+ years of Pharmacy Benefit Management (PBM) experience




  • Experience with Agile Development method




  • Ability to clearly document business requirements.




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 103,300 - 172,100 USD / yearly, depending on relevant factors, including experience and geographic location.


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


We want you to be healthy, balanced, and feel secure.
Thats why youll enjoy a comprehensive range of benefits, with a focus on supporting your whole health.
Starting on day one of your employment, youll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs.
We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays.
For more details on our employee benefits programs, visit Life at Cigna Group .


About The Cigna Group


Doing something meaningful starts with a simple decision, a commitment to changing lives.
At The Cigna Group, were dedicated to improving the health and vitality of those we serve.
Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients.
Join us in driving growth and improving lives.


Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.


If you require reasonable accommodation in completing the online application process, please email:

SeeYourself@cigna.
com
for support.
Do not email
for an update on your application or to provide your resume as you will not receive a response.


The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible.
Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment.
These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Recommended Skills

  • Agile Methodology
  • Business Requirements
  • Clinical Works
  • Coaching And Mentoring
  • Communication
  • Decision Making

Position Details

POSTED:

Feb 01, 2024

EMPLOYMENT:

Full-time

SALARY:

172100 per year

SNAPRECRUIT ID:

S-1707364332-597ea443cb236250f25f5e2481fd9a80

LOCATION:

Pennsylvania United States

CITY:

Philadelphia

Job Origin:

jpick2

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ROLE SUMMARY:


This position is responsible for managing the Cigna Clinical Operations Criteria team that ensures drug coverage policy (criteria) intent is implemented on time with consistency and accuracy across Cigna's UM intake tool(s). The position works closely with matrix partners across clinical product, Medical Management, Express Scripts, Coverage Policy Unit and the Cigna Coverage Review Department to oversee the gathering and implementation of drug criteria intent. The role also is responsible for working with technical and business leads for strategic planning, development, and deployment of enterprise initiatives related to drug criteria implementation (intent gathering and installation) management.


RESPONSIBILITIES:


  • Manage a small to mid-size team of production pharmacists and analysts who are responsible for timely and accurate drug criteria implementation within the UM intake tool(s) through systems, workflows, and processes.




  • Oversight of Cigna Clinical Operations Criteria implementation throughout the process




  • Identify, implement, and champion lessons learned and process improvements for the team driving change when and where needed.




  • Responsible for overseeing all drug criteria implementation processes and activities partnering with all levels of management, teams, and employees.




  • Owns the overall workflow management for criteria implementation tasks associated with changes to the drug coverage policies.




  • Partners with matrix partners to coordinate reporting and quality assurance activities to ensure implementation within the operating systems accurately meets the business intent.




  • Responsible for managing, creating and maintaining implementation team job aids, SOPs, and tools.




  • Ensures that drug criteria implementation issues are escalated to the appropriate area.




  • Develops strategic plan for team.




  • Responsible for working with technical and business leads for the development and maintenance of criteria implementation management.




  • Responsible for working with Enterprise projects that impact criteria implementation management.




  • Owns the deployment and enablement of enterprise activities associated with implementation.




QUALIFICATIONS:


Required:


  • Licensed Pharmacist




  • Bachelors degree in pharmacy (required); PharmD (preferred)




  • Ability to operate independently.




  • Proven ability to organize, hold others accountable, and manage timelines.




  • Highly experienced with negotiation, problem solving, analyzing, and decision making.




  • Proven communication, interpersonal and collaboration skills




  • Ability to operate in an ambiguous operations environment.




  • Demonstrated ability to work in a highly matrixed environment.




  • Skilled with operating and managing through an organization.




  • Highly skilled in MS Excel and advanced proficiency in MS Office.




  • Seasoned presentation skills and comfortable in front of diverse audiences.




Preferred:


  • Experience in managing small to mid-sized teams.




  • Excellent at teaching, motivating, inspiring, and developing employees.




  • Proven ability to engage a team and drive a results-focused team atmosphere.




  • Prior Pharmacy Benefit Management (PBM) experience working with criteria implementation.




  • First Data Bank experience




  • Minimum of 7-10 years experience in the healthcare industry




  • 5+ years of Pharmacy Benefit Management (PBM) experience




  • Experience with Agile Development method




  • Ability to clearly document business requirements.




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 103,300 - 172,100 USD / yearly, depending on relevant factors, including experience and geographic location.


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


We want you to be healthy, balanced, and feel secure. Thats why youll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, youll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group .


About The Cigna Group


Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, were dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.


Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.


If you require reasonable accommodation in completing the online application process, please email:

SeeYourself@cigna.com
for support. Do not email
for an update on your application or to provide your resume as you will not receive a response.


The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Recommended Skills

  • Agile Methodology
  • Business Requirements
  • Clinical Works
  • Coaching And Mentoring
  • Communication
  • Decision Making

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