Clinical Program Manager - Evernorth - Remote (Clinical Operations Support & Custom Services)
About The Position
The Clinical Program Manager, Custom Implementation & Operations Support Services, leads Clinical Program Advisors and analysts who support clinical program operations, custom client implementations, specialty programs, analyst services, and operational process improvements. The role partners across clinical, implementation, product, technology, business, and Global Service Partners to translate requirements into accurate, timely, and sustainable operational solutions. The position provides strategic and day-to-day leadership across custom client support, specialty program implementation, operational governance, data quality, process optimization, and ongoing pharmacy benefit and clinical configuration activities. The manager oversees operational support services and custom client requests, develops sustainable processes, supports configuration reviews, drives continuous improvement, and leads teams and cross-functional initiatives. The position is remote and requires a cable broadband or fiber optic internet connection of at least 10 Mbps download and 5 Mbps upload when working from home.
Requirements
- Pharmacy degree (BSPharm or PharmD) and an active pharmacist license in good standing.
- Five or more years of healthcare, pharmacy benefit management, clinical operations, or related experience.
- Relevant experience supporting custom client programs and solutions within pharmacy benefit management or clinical operations.
- Strong understanding of existing high-level-of-effort products and the operational processes required to maintain them.
- Two or more years of leadership or people-management experience.
- Demonstrated ability to lead operational teams in a highly matrixed environment.
- Strong project management, organizational, analytical, and problem-solving skills.
- Excellent verbal and written communication skills.
- Ability to manage multiple priorities and competing deadlines.
- Ability to influence stakeholders across business, operational, and technical organizations.
- Proficiency with Microsoft Office, including Excel and PowerPoint.
Nice To Haves
- Experience in pharmacy benefit management, formulary management, utilization management, or clinical configuration.
- Experience supporting specialty pharmacy programs and custom client implementations.
- Knowledge of DCRS, CRS, FRS, Polaris, FIT, or related clinical configuration systems.
- Experience working with offshore or geographically distributed teams.
- Pharmacy, healthcare operations, or clinical program management background.
Responsibilities
- Lead, coach, and develop clinical operations analysts and support resources.
- Oversee Clinical Operations Support Services, Specialty, Analyst Support Services, and Custom Support Services activities.
- Manage operational support for specialty programs, Pathwell, preventive programs, and other high-maintenance clinical initiatives.
- Develop new operational processes for products and projects, establish sustainable maintenance models, and transition ongoing ownership to appropriate operational teams.
- Partner with matrix stakeholders to gather requirements, assess operational impacts, and develop implementation approaches.
- Identify and leverage automation and AI solutions to improve team efficiency, data quality, workflow optimization, and operational scalability.
- Oversee and support Rx Configuration PBAB requests, including exception review, consultation, and risk and feasibility assessment.
- Ensure accurate and timely execution of custom client requests, utilization management setups, drug list maintenance, and operational support services.
- Develop and maintain standard operating procedures, job aids, governance processes, and team documentation.
- Manage issue resolution, escalations, risk identification, and corrective action plans.
- Collaborate with technology, product, implementation, and operational partners on new products, enhancements, and strategic initiatives.
- Support audit readiness, quality reviews, compliance activities, and operational controls.
- Monitor operational performance, service levels, capacity, and workload distribution.
- Lead cross-functional projects and organizational initiatives.
- Identify staffing, training, and development needs, build team capabilities, and reduce key-person dependencies.
- Foster collaboration, accountability, adaptability, innovation, and continuous improvement.
Benefits
- Medical insurance
- Vision insurance
- Dental insurance
- Well-being and behavioral health programs
- 401(k)
- Company-paid life insurance
- Tuition reimbursement
- A minimum of 18 days of paid time off per year
- Paid holidays
- Leaves of absence
- Eligibility to participate in an annual bonus plan
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What This Job Offers
Job Type
Full-time
Career Level
Manager
