Clinical Program Advisor - Express Scripts - Hybrid (Rebate Strategy)

Provides counsel and advice to top management on significant Clinical Program Management matters, often requiring coordination between organizations. Focuses on providing thought leadership and technical expertise across multiple disciplines. Recognized internally as “the go-to person” for the most complex Clinical Program Management assignments. Represents company externally and serves as conduit to educate and enable care coordination between stakeholders resulting in an optimal healthcare experience and customer satisfaction. Serves as clinical advisor to the sales organization, providing ongoing product and industry knowledge / education that positively influence cost, quality and customer satisfaction.

JOB SUMMARY

The Clinical Program Advisor provides insight and guidance on complex clinical rebate modeling assignments / projects. Exercises considerable creativity, foresight, and judgment in conceiving, planning, and delivering initiatives. Uses clinical professional knowledge and acumen to advise functional leaders and educate other team members. Delivers client clinical modeling support, but also works on broader projects, which require understanding on a more global perspective. Recognized internally as a clinical subject matter expert. Serves as clinical advisor resource providing ongoing product and industry knowledge / education that positively influence cost, quality and customer satisfaction.

ESSENTIAL FUNCTIONS :

• Perform drug level analysis on current custom and standard clients
• Leverage and apply applicable contracted rebate rates based on client clinical criteria
• Work closely with the underwriter to confirm utilization, strategy and contract alignment
• Perform quality assurance reviews on results to ensure accuracy
• Field clinical questions from other renewal team members
• Ability to performs independent modeling with little to no modeling oversight by Sr. Manager / Director
• Identifies and recommends process improvement to streamline renewal modeling
• Provide analysis to support development and implementation of rebate pricing strategies
• Review custom health plan Utilization Management policies for rebate eligibility or adherence to contract rebate terms
• Collaborate with SAM and Underwriting teams to understand current client financial position and rebate approach as well as strategic options for market checks and renewals.
• Ideate and propose strategic rebate optimization opportunities and understand long-term benefits and challenges associated with those optimization opportunities.
• Support team leadership by reviewing key / complex client rebate modeling and "translating" modeling primary components and assumptions into concise and understandable format and messaging for leadership reviews and Pricing Committee.
• Evaluate client data, create scenarios, and provide expert modeling and guidance for existing clients in alignment with department strategic objectives that drive value to both clients and Express Scripts.
• Partner with clinical sr. advisor peers to analyze the financial impact of client requested formulary changes to both the client and Express Scripts.
• Work on special projects and presentations as needed for the rebate modeling teams.

QUALIFICATIONS :