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Job Description
Job Summary
The Network Operations Advisor role is part of the Retail Account Management Team that sits within the network compliance organization. The primary responsibility of this role is to manage a portfolio of Chain, PSAO, and independent pharmacy providers with complex escalated issues, provide education to these providers and deliver performance data and metrics. This role requires a high volume of issue research and resolution on a daily basis for internal and external partners. The network operations advisor also supports execution of operational activities with Retail Network in accordance with ESIxe2x80x99s work plan and ensures compliance with requirements for Express Scripts clients and any regulatory agencies, while supporting the needs of chain providers. This role also supports Supply Chain Sr. Management in the execution of strategic plans within our network. This role is required to work independently to lead, own and manage the relationship of assigned chain and PSAO pharmacy providers, while also offering SME level support to our independent affiliated providers. Managing the relationship is complete with performance management in strategic planning, analytical development and processing, as well as operational management of any requirements that impact Retail Network Providers. This role is also required to champion cross-functional issue escalations/resolution; communicate progress and key milestones to appropriate internal partners in a timely manner.
ESSENTIAL FUNCTIONS
- Responsible for the relationship and daily operational support of complex/high profile chain, PSAO, and independently affiliated providers. Operational support includes, but not limited to, claim investigation, escalated issue management.
- Responsible for cross functional collaboration with internal and external teams and provide on-going support for Health Plan Sponsors and their requirements.
- Work with appropriate teams for data mining and analysis of files to ensure efficient and effective communication to Providers.
- Serves as subject matter expert for team on analytics and technical support.
- Execution of assigned strategic work plan initiatives including but not limited to network development, implementing initiatives benefiting Express Scripts clientele and promoting Corporate and Departmental objectives.
- Assists with development of strategic plans for assigned providers, providing consultative input to further foster strong provider relationships.
- A key extension of the Provider Strategy and Contracting Management teams- supporting channel development program launches and communication of program implementation and status.
QUALIFICATIONS
- Bachelorxe2x80x99s degree in related field
- At least 3-5 years of related work experience.
- Knowledge of the health-care, PBM industry and products.
- Excellent oral, written communication and presentation skills.
- Problem solving and analytical skills.
- Project management/organizational skills.
- Ability to work cross-functionally to research and resolve complex client/provider issues on a daily basis.
- External Relationship building.
- Strong focus on customer service.
- Ability to manage simultaneous escalated issues with tight timelines.
- Excellent PC skills including Microsoft Office and internet experience.
- Ability to adapt in a dynamic work environment, learn quickly, solve problems and make decisions with minimal supervision.
- Demonstrated ability to manage projects, utilizing proven project management processes.
Strong leadership skills and the ability to effectively engage with cross-functional leadership.
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.
About Evernorth Health Services
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. 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: [email protected] for support. Do not email [email protected] 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.
