Clinical Programs Manager

About the role

The clinical programs manager is responsible for applying their clinical knowledge and expertise to develop and optimize clinical programs for both pharmacy and medical benefit clients. The role oversees the lifecycle of clinical and cost savings programs, ensures programs deliver value, meet quality and operational standards, and achieve clinical and/or financial outcomes for clients. The clinical programs manager collaborates with both internal and external stakeholders to develop and maintain clinical programs, such as analytics, product, finance, marketing, client services, sales, operations, and vendors.

Responsibilities

• Collaborate with stakeholders to develop, implement, and maintain clinical programs across all lines of business, including but not limited to drug utilization review, opioid management, adherence, pharmacogenomics, disease management, and other clinical initiatives.
• Partner with cross-functional teams to ensure successful program planning, implementation, execution, and ongoing management.
• Maintain and update clinical program resources, including drug lists, clinical rules, job aids, call scripts, SOPs, training materials, and related documentation.
• Provide pharmacist expertise for program workflows, outreach strategies, prescriber communications, and clinical decision‑making.
• Own relationship with and provide oversight of third‑party vendors to administer clinical programs with emphasis on disease management.
• Support the go‑to‑market strategy of clinical products including pricing, marketing, and implementation.
• Support RFI and RFP submissions.
• Partner with internal and external stakeholders to support program launches, workflow enhancements, reporting initiatives, client implementations, and clinical projects.
• Monitor program performance, claims activity, and reporting requirements while ensuring effective communication among stakeholders.
• Identify operational trends and recommend process improvements that enhance quality, efficiency, member outcomes, and program effectiveness.
• Support manager and department initiatives through special projects, operational support, and cross‑functional collaboration.
• Assist with staff training, onboarding, and development activities as needed.
• Serve as preceptor for student pharmacists and residents as required.
• Maintain compliance with all applicable federal, state, local, and organizational regulations, policies, and guidelines.
• Adhere to HIPAA requirements, internal SOPs, and company policies in the performance of daily responsibilities.
• Remain current on organizational communications, clinical updates, and process changes and apply them appropriately to daily work activities.

Requirements

• Active, unrestricted pharmacist license
• 2+ years of prior health plan/PBM/managed care and/or clinical program management experience and/or completion of a PGY1 Managed Care Pharmacy Residency Program or fellowship
• Excellent communication (oral and written) and organizational skills
• Ability to work independently with minimal supervision, stay productive in a hybrid, fast‑paced environment
• Self‑motivated and detail‑oriented problem solver
• Ability to handle multiple competing priorities in a dynamic environment and collaborate in a team
• Experience with clinical analytics, reporting, and/or working with large data sets

Qualifications

• Clinical program management, quality improvement, population health management, and/or cost savings initiative experience
• Experience managing medication lists
• Experience supporting cross‑functional program implementation and workflow optimization
• Experience with Confluence, Jira, Tableau, Salesforce
• Experience with all lines of business (Medicare, Medicaid, Commercial/Exchange)
• Experience with PQA/Star/HEDIS measures

Pay

• New York, NY: $135,000 USD – $145,000 USD
• Denver, CO: $135,000 USD – $145,000 USD
• Charlotte, NC: $135,000 USD – $145,000 USD