Clinical Domain Project Manager – PBM

This is a fully remote position, open to applicants in Arizona, +2 more states.

📋 Description

• Oversee pharmacy clinical projects from initiation through to planning, execution, monitoring, and closure.

• Create and sustain integrated project plans, schedules, milestones, dependencies, and deliverables.

• Lead requirements gathering sessions, design reviews, solution validation, testing, and implementation activities.

• Coordinate efforts across clinical, operational, technical, and business workstreams.

• Administer project budgets, scope, schedules, risks, issues, assumptions, and dependencies.

• Assist with drug coverage administration, Preferred Drug List (PDL) management, prior authorization, electronic prior authorization (ePA), and drug utilization review (DUR) initiatives.

• Act as the main point of contact for clients, clinical teams, and internal project stakeholders.

• Facilitate decision-making sessions and executive governance meetings.

• Report project status, risks, issues, and mitigation strategies to leadership.

• Cultivate relationships with pharmacy directors, clinical pharmacists, business analysts, product teams, and external vendors.

• Ensure adherence to federal and state Medicaid requirements and assist with audit, regulatory review, and contractual reporting readiness.

• Coordinate activities involving CMS, Medicaid agencies, PBMs, healthcare partners, pharmacy system vendors, clinical review organizations, and state stakeholders.

• Manage integrations, dependencies, issue resolution, and escalations with external partners.

• Lead implementation readiness assessments and go-live preparations.

• Organize training, deployment, cutover, stabilization, continuous improvement, and lessons-learned initiatives.

• Formulate implementation plans, communication strategies, and transition-to-operations procedures.

⛳️ Requirements

• Proven success in leading large-scale healthcare or pharmacy benefit management (PBM) implementations.

• Experience in managing multiple workstreams and vendors concurrently.

• Proficient in overseeing end-to-end lifecycle activities from project initiation to post go-live support.

• Familiarity with Preferred Drug List (PDL) administration.

• Background in prior authorization (PA) programs.

• Knowledge of electronic prior authorization (ePA) and drug utilization review (DUR).

• Experience in clinical policy administration and utilization management initiatives.

• Expert-level management of schedule performance using Microsoft Project.

• Proficient in deliverable management, including oversight of Medicaid deliverables.

• Capable of managing risks, actions, issues, and decisions (RAID).

• Familiar with project controls based on the Project Management Body of Knowledge (PMBOK).

• Skilled in cross-domain coordination across claims, provider, member, clinical, rebate, and portal functions.

• At least seven years of project management experience.

• Minimum of seven years of experience supporting Pharmacy Benefit Management (PBM) Medicaid programs.

• PMP certification is preferred but not mandatory.

• Must be eligible to work in the United States.

• Sponsorships are not available.

• Successful completion of a background check is required prior to onboarding.

• Ability to occasionally lift up to 20 lbs.

• Capability to talk, hear, sit, stand, and use technology tools such as a laptop for extended periods.

• Close vision and ability to adjust focus.

🏝️ 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