Clinical Domain Project Manager (PBM)

Briljent•Atlanta, GA

6d•Remote

About The Position

The Clinical Domain Project Manager plans, coordinates, and delivers pharmacy clinical initiatives within a Medicaid, pharmacy benefit management (PBM), and healthcare payer environment. This role serves as the primary liaison between business stakeholders, clinical pharmacists, operational teams, technology teams, and external partners to ensure successful implementation of pharmacy clinical solutions and regulatory requirements. Assigned projects span drug coverage administration, Preferred Drug List (PDL) management, prior authorization, utilization management, drug utilization review, clinical criteria configuration, and pharmacy system implementations, with accountability for project governance, schedule management, stakeholder communications, risk management, and delivery of business outcomes. This is a fully remote, full time engagement with an anticipated duration of ten months and an immediate start. No travel is required, and a background check must be successfully completed prior to onboarding. Must be eligible to work in the United States. No sponsorships are available at this time.

Requirements

Demonstrated success leading large-scale healthcare or pharmacy benefit management (PBM) implementations
Experience managing multiple workstreams and vendors simultaneously
Experience leading end-to-end lifecycle activities from project startup through post go-live support
Experience with Preferred Drug List (PDL) administration
Experience with prior authorization (PA) programs
Experience with electronic prior authorization (ePA) and drug utilization review (DUR)
Experience with clinical policy administration and utilization management initiatives
Expert-level schedule performance management using Microsoft Project
Deliverable management, including Medicaid deliverable oversight
Risks, actions, issues, and decisions (RAID) management
Project controls based on the Project Management Body of Knowledge (PMBOK)
Cross-domain coordination across claims, provider, member, clinical, rebate, and portal functions
Seven or more years of project management experience
Seven or more years of experience supporting Pharmacy Benefit Management (PBM) Medicaid programs

Nice To Haves

Project Management Professional (PMP) certification preferred, not required

Responsibilities

Leads pharmacy clinical projects through initiation, planning, execution, monitoring, and closure
Develops and maintains integrated project plans, schedules, milestones, dependencies, and deliverables
Facilitates requirements gathering, design reviews, solution validation, testing, and implementation activities
Coordinates cross-functional teams across clinical, operational, technical, and business workstreams
Manages project budgets, scope, schedule, risks, issues, assumptions, and dependencies
Supports implementation and enhancement of drug coverage administration, Preferred Drug List (PDL) management, prior authorization (PA) programs, electronic prior authorization (ePA), and drug utilization review (DUR)
Ensures clinical program requirements are accurately translated into system and operational solutions
Serves as primary point of contact for client, clinical, and internal project stakeholders
Facilitates decision-making discussions and executive governance meetings
Communicates project status, risks, issues, and mitigation strategies to leadership
Builds collaborative relationships with pharmacy directors, clinical pharmacists, business analysts, product teams, and external vendors
Ensures project deliverables comply with federal and state Medicaid requirements
Supports readiness for audits, regulatory reviews, and contractual reporting obligations
Coordinates implementation efforts involving the Centers for Medicare and Medicaid Services (CMS), Medicaid agencies, pharmacy benefit managers (PBMs), and healthcare partners as applicable
Maintains traceability between business requirements, design decisions, testing results, and implemented solutions
Coordinates activities with PBMs, pharmacy system vendors, clinical review organizations, and state stakeholders
Manages integration and dependency tracking across external partners
Facilitates issue resolution and escalation management to meet project objectives
Leads implementation readiness reviews and go-live planning activities
Coordinates training, deployment, cutover, and stabilization efforts
Develops implementation plans, communication strategies, and transition-to-operations procedures
Supports continuous improvement initiatives and lessons-learned activities