Clinical Program Manager – Clinical Operations Support, Custom Services

Job not on LinkedIn

🔥 16 hours ago

🇺🇸 United States – Remote

💵 $106k - $176.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🏥 Clinical Operations

👻 Ghost score 0%

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The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛡️ Insurance

Healthcare • Insurance

The Cigna Group is a global health services company that provides medical, dental, pharmacy, behavioral and supplemental insurance products and benefits to individuals, families, employers, brokers, providers and Medicare beneficiaries. It offers employer-sponsored group plans, individual and family plans (including Open Enrollment offerings), Medicare, international health insurance covering more than 200 countries, and digital member services through the myCigna platform (including telehealth and claims management). Its products are delivered through operating subsidiaries such as Cigna Health and Life Insurance Company and other regional affiliates.

📋 Description

• Lead, coach, and develop clinical operations analysts and support resources • Oversee Clinical Operations Support Services, Specialty, Analyst Support Services, and Custom Support Services • Manage operational support for specialty programs, Pathwell, preventive programs, and other high-maintenance clinical initiatives • Develop operational processes for products and projects and establish sustainable maintenance models • Transition ongoing process ownership to appropriate operational teams • Gather requirements, assess operational impacts, and develop implementation approaches with matrix stakeholders • Drive automation and AI solutions to improve efficiency, data quality, workflows, and scalability • Oversee and support Rx Configuration PBAB requests, including exception review, consultation, risk, and feasibility assessment • Execute 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 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 and build team capabilities • Foster collaboration, accountability, adaptability, innovation, and continuous improvement

🎯 Requirements

• Pharmacy degree (BSPharm or PharmD) • 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 high-level-of-effort products and operational maintenance processes • Two or more years of leadership or people-management experience • 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 business, operational, and technical stakeholders • Proficiency with Microsoft Office, including Excel and PowerPoint • Preferred: experience in pharmacy benefit management, formulary management, utilization management, or clinical configuration • Preferred: experience supporting specialty pharmacy programs and custom client implementations • Preferred: knowledge of DCRS, CRS, FRS, Polaris, FIT, or related clinical configuration systems • Preferred: experience working with offshore or geographically distributed teams • Preferred: pharmacy, healthcare operations, or clinical program management background • For home-based work, cable broadband or fiber optic internet service with at least 10 Mbps download/5 Mbps upload

🏖️ Benefits

• Annual bonus plan eligibility • Medical, vision, and dental benefits • Well-being and behavioral health programs • 401(k) • Company-paid life insurance • Tuition reimbursement • Minimum of 18 days of paid time off per year • Paid holidays • Leaves of absence

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