About the position
The IFP Care Navigator - Clinical Pharmacist position at The Cigna Group is a part-time remote role that focuses on serving as a customer advocate to coordinate, support, and guide care for customers and their families. The Care Navigator will embody and promote the Care Solutions cultural beliefs, which emphasize accountability, collaboration, and a commitment to delivering world-class customer experiences. The role requires a proactive approach to problem-solving and a dedication to improving health outcomes through effective communication and collaboration with various stakeholders, including case management teams, medical directors, and healthcare providers. In this position, the Clinical Pharmacist will review pharmacy data to identify market and member trends, enabling the development of targeted interventions. They will navigate multiple analytical programs and clinical systems to enhance clinical and financial outcomes while supporting trend management. The role involves participating in innovative programs aimed at improving outcomes for high-needs populations and conducting evaluations of customer health records to educate and engage customers in managing their drug regimens and chronic conditions effectively. The Clinical Pharmacist will establish credibility as a trusted partner to provider partners, offering interventions and recommendations based on evidence-based protocols. They will assist customers in accessing cost-effective treatments, close gaps in medication adherence, and provide clinical consultations on various medication-related inquiries. The role also includes tracking daily activities to monitor volume and outcomes, adhering to organizational performance measures, and completing required training to maintain clinical expertise. Overall, this position is integral to ensuring that customers receive comprehensive support in managing their health, with a focus on addressing social determinants of health and promoting medication adherence.
Responsibilities
- Review pharmacy data to extract market and member trends to develop targeted interventions.
- Navigate multiple analytical programs and clinical systems to improve clinical and financial outcomes.
- Collaborate with case management, behavioral clinicians, Medical Directors, and member's providers to provide whole-person health support.
- Participate in innovative programs that drive improved outcomes for high-needs populations.
- Perform targeted evaluations of customer health records and educate customers on managing their drug regimens and chronic conditions.
- Establish credibility as a trusted partner and advisor to provider partners, addressing quality measures and clinical pharmacy concerns.
- Assist in driving customers to cost-effective treatments, including brand-to-generic medication utilization.
- Close gaps in medication adherence and assist customers with compliance of refill rates.
- Provide clinical consultation and drug information to matrix partners and navigator team.
- Interface with customers, family members, providers, and internal partners to coordinate customer needs through various communication methods.
- Participate in rapid-cycle improvement processes to meet member trends.
- Track daily activities to trend volume and outcomes.
- Follow standard operating procedures and prioritize work to meet commitments aligned with organizational goals.
- Complete training within the communicated time limit as required per role.
- Demonstrate evidence of continuing education to maintain clinical expertise and certification.
- Proactively resolve immediate customer needs and assess for resources to aid with Social Determinants of Health needs.
Requirements
- Active, registered Pharmacist/PharmD in good standing in the state of residence.
- Minimum of 2-3 years of clinical pharmacy experience.
- Successful completion of an ASHP accredited pharmacy residency preferred.
Nice-to-haves
- Board of Pharmacy Specialties (BPS) Certification preferred.
- Highly evolved clinical pharmacy skills and knowledge of chronic condition/population health management.
- Direct Managed Care Health Plan and/or Pharmacy Benefit Manager (PBM) experience.
- Strong understanding of health disparities/SDOH and their impact on health outcomes.
- Previous experience with pharmacy quality HEDIS measures.
- Experience in Medicaid and/or Marketplace/Accountable Care plans.
- Expertise in specialty drug therapy management for high-cost and complex conditions.
- Experience with drug utilization trend/performance reporting and pharmacy benefit design and implementation.
- Ability to manage multiple, complex situations in a challenging environment.
Benefits
- Medical, vision, and dental insurance coverage starting on day one.
- Well-being and behavioral health programs.
- 401(k) with company match.
- Company paid life insurance.
- Tuition reimbursement.
- A minimum of 18 days of paid time off per year.
- Paid holidays.
