Job Description:

POSITION SUMMARY

The Program Management Lead Analyst supports the Senior Manager and other analysts in continued review and implementation of additions, changes or deletions to client clinical rules and determination of their impact on client rebate eligibility. The Program Management Lead Analyst will be responsible for establishing queries to gather data from appropriate resources, in addition to manual review of appropriate resources, for analysis and root cause identification of variances.  As a Program Management Lead Analyst, your duties include review of over 300 custom formularies for externally adjudicated client(s), continuously reviewing a high volume of changes, additions and deletions to client clinical rules impacting rebate eligible drugs, and attending external client meetings to discuss analyses.

ESSENTIAL FUNCTIONS

• Continuously integrate Clinical Rules System database for additions, changes or deletions to client clinical rules with impacts to rebate eligible products. Work with Manager when new rules are identified to determine appropriate interpretation of the clinical rule impact on rebates.


• Consolidate clinical rules with impacts to rebate drug products to a single list of assigned ids for upload and utilization within the FRS rebate system.


• Prepare files for upload process to FRP rebate system. Assure BDRO Control tables are accurate and updated timely when new rule IDs are added


• Work with externally adjudicated client(s) and account management to assure all custom formulary rules not housed within Express Scripts systems are received and populated within control tables. Assure new rules identified are forwarded to Senior Manager for appropriate interpretation and addition to control tables.


• Work cross-functionally with Pharma Contracting, Clinical Account Executives, Pharma Invoicing and others to assure appropriate application of clinical rules and impacts on rebated drug products.


• Responsible for monitoring reports and proactively perform analyses and report findings to internal/external clients.


• Develop and document appropriate policy and procedures for analysis and appropriate determination of client eligibility for rebate enhancement and exclusion options.  Continually update documents as processes change and review at a minimum on an annual basis


• Review clinical utilization criteria and compare to Pharma contracts to ensure accurate invoicing of each product


• Interpret contract changes to determine impact to rebates, and to present to the team for review of impact to clients


• Other duties as assigned.

QUALIFICATIONS

• College Degree in Healthcare, Business, Mathematics, or Accounting required


• 2+ years of work experience in PBM, Pharmaceutical, or Healthcare industry required


• Strong analytical, planning, problem identification and resolution skills required.


• Demonstrated self-initiative


• Effective communication with internal and external individuals in various functional areas and at all levels of management


• Knowledge of ESI’s products and services preferred.


• Experience with Pharmaceutical Contracts and/or Pharmacy Benefits strongly preferred


• Understanding of and experience with quality and process improvement concepts, methodologies


• Proven ability to plan for and integrate multiple tasks concurrently as well as work independently


• Experience reading and understanding clinical/medical terminology, PA criteria and medication package inserts


• Skilled in MS Excel

ABOUT EXPRESS SCRIPTS

Advance your career with the company that makes it easier for people to choose better health.

Express Scripts is a leading healthcare company serving tens of millions of consumers. We are looking for individuals who are passionate, creative and committed to creating systems and service solutions that promote better health outcomes. Join the company that Fortune magazine ranked as one of the "Most Admired Companies" in the pharmacy category. Then, use your intelligence, creativity, integrity and hard work to help us enhance our products and services. We offer a highly competitive base salary and a comprehensive benefits program, including medical, prescription drug, dental, vision, 401(k) with company match, life insurance, paid time off, tuition assistance and an employee stock purchase plan.

Express Scripts is an equal opportunity employer/disability/veteran

For this position, we anticipate offering an annual salary of $69,500 - $115,800, depending on relevant factors, including experience and geographic location.

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

Helping our customers achieve healthier, more secure lives is at the heart of what we do. While you take care of our customers, we’ll take care of you through a comprehensive benefits program that helps you be at your best. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and best in class 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 dozens of corporate discounts on essentials you use every day. For more details on our employee benefits programs, please visit the “Life at Cigna” tab on our careersite: www.cigna.com/careers

About Cigna

Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you’ll enjoy meaningful career experiences that enrich people’s lives. What difference will you make?

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

Cigna 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.

Apply Now