Clinical Pharmacist Medicaid Moen
United Kindom
5d ago

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Role Summary :

The Medicaid Clinical Pharmacist assists with the development and execution of initiatives that improve the quality and cost effectiveness of the Pharmacy Benefit for Cigna-

HealthSpring Medicaid line of business. This role will include working with a team of clinical pharmacist to ensure that all State and CMS regulations are met.

Initiatives will include reviewing and tracking State and CMS guidance, performing analysis of utilization and financial data, along with coordinating with the internal subject matter experts to ensure operational compliance and efficiency.


  • Reviews, tracks and implements Medicaid regulatory requirements
  • Works with the State and internal Compliance Dept. to interpret guidance and regulatory requirements and ensure they are applied appropriately
  • Participate in regular meetings with PBM to ensure contractual compliance and operational efficiency
  • Assists with the analysis of drug utilization data to identify trends and develop management strategies
  • Conduct regular reviews and analysis of Medicaid pharmacy financial performance
  • Review pharmacy prior authorization and appeals requests and make determinations based on state criteria and clinical appropriateness
  • Coordinate with other departments regarding deliverables, working closely with subject matter experts to ensure deadlines are met
  • Handles phone inquiries from both internal and external customers
  • Qualifications

  • PharmD or Bachelor’s degree in Pharmacy with advanced degree.
  • Minimum of 3 to 5 years of managed care experience or managed care residency.
  • Proficient in Microsoft Office such as Word, Excel, PowerPoint, Access and Outlook
  • Knowledge of State and CMS regulatory requirements with emphasis on the State of Texas Medicaid.
  • Strong analytical skills and understanding of managed care finance and operations.
  • Demonstrated skill in verbal and written communication, problem solving, organizing, and time management
  • Have the ability to establish and maintain effective, courteous, and confidential relationships with coworkers, staff, employer groups, and members
  • Must be able to register as a licensed pharmacist in the State of Texas, or eligible to be licensed within 60 days
  • Qualified applicants will be considered without regard to race, color, age, disability, sex (including pregnancy), childbirth 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 an accommodation based on your physical or mental disability please email : SeeYourself Do not email SeeYourself cigna.

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

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