Clinical Domain Project Manager

Role Description

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.

Qualifications

• 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

Requirements

• Seven or more years of project management experience
• Seven or more years of experience supporting Pharmacy Benefit Management (PBM) Medicaid programs
• Project Management Professional (PMP) certification preferred, not required

Benefits

• Health Care Plan (Medical, Dental & Vision)
• Retirement Plan (401k, IRA)
• Life Insurance (Basic, Voluntary & AD&D)
• Paid Time Off (Vacation, Sick & Public Holidays)
• Short Term & Long Term Disability
• Work From Home
• Wellness Resources