Clinical Program Sr. Manager - Express Scripts - Remote

Express Scripts Pharmacy Benefit Services; South Dakota; On-site; USD 125,000 - 209,000; Full time

Benefits offered by this job

Health benefits

401(k) plan

Life insurance

Tuition reimbursement

Paid time off

Job summary

The Cigna Group is seeking a Clinical Operations Senior Manager to lead accurate, timely implementation of pharmacy clinical decisions within the claims processing system. You will partner with clinical, product, technical, and business teams to deploy enterprise initiatives and oversee AI-enabled tools with human oversight.

This role requires strong people leadership and change management, with a focus on operational discipline and innovative solutions to complex business challenges in a

Qualifications

• Active pharmacist license is required.
• Bachelor's degree in Pharmacy; PharmD preferred.
• 7–10 years of healthcare industry experience preferred.

Responsibilities

• Lead a team of onshore pharmacists and analysts for timely, accurate implementation of clinical intent.
• Champion lessons learned and drive continuous process improvement across the team.
• Oversee installation processes: workflow management, QA, SOPs, and tools.
• Coordinate reporting, training plans, and escalation of issues to leaders.
• Develop and enhance clinical implementation management processes with tech and business leads.
• Support enterprise initiatives affecting clinical implementation activities.
• Manage staffing, mentoring, and continuing education initiatives.
• Promote knowledge sharing and cross-functional collaboration.

Skills

Active pharmacist license

Excel proficiency

Clinical criteria implementation

PBM familiarity

Communication skills

Education

Bachelor's degree in Pharmacy

PharmD preferred

Tools

First Databank

Job description

ROLE SUMMARY

The Clinical Operations Senior Manager is responsible for leading the accurate and timely implementation of Cigna pharmacy clinical decisions, including drug coverage, formulary, and utilization management, within the pharmacy claims processing system. This role partners closely with clinical pharmacy, Express Scripts, Product, technical teams, and business stakeholders to ensure clinical intent is implemented effectively and consistently. The Senior Manager also supports strategic planning, development, and deployment of enterprise initiatives related to clinical implementation within the claims processing environment. This leader will assess, champion, and oversee responsible use of AI-enabled tools and team-led agents that support Clinical Operations workflows, reduce manual effort, strengthen quality controls, and improve operational consistency while maintaining appropriate human oversight. This leader must demonstrate strong people leadership, change leadership, operational discipline, and the ability to drive innovative solutions to complex business challenges.

Summary

The Clinical Operations Senior Manager is responsible for leading the accurate and timely implementation of Cigna pharmacy clinical decisions, including drug coverage, formulary, and utilization management, within the pharmacy claims processing system. This role partners closely with clinical pharmacy, Express Scripts, Product, technical teams, and business stakeholders to ensure clinical intent is implemented effectively and consistently. The Senior Manager also supports strategic planning, development, and deployment of enterprise initiatives related to clinical implementation within the claims processing environment. This leader will assess, champion, and oversee responsible use of AI-enabled tools and team-led agents that support Clinical Operations workflows, reduce manual effort, strengthen quality controls, and improve operational consistency while maintaining appropriate human oversight. This leader must demonstrate strong people leadership, change leadership, operational discipline, and the ability to drive innovative solutions to complex business challenges.

Responsibilities

• Lead a team of onshore pharmacists and onshore and offshore analysts responsible for the timely and accurate implementation of clinical intent.
• Champion lessons learned, operational consistency, and continuous process improvement across the team.
• Oversee clinical installation processes and activities, including:
  • Overall workflow management.
  • Coordination of reporting and quality assurance activities.
  • Creation and maintenance of installation team job aids, SOPs, and tools.
  • Escalation of clinical implementation issues to the appropriate teams or leaders.
  • Development and execution of team training plans.
• Partners with technical and business leads to develop, maintain, and enhance clinical implementation management processes.
• Lead deployment, enablement, and operational support for enterprise initiatives that impact clinical implementation activities.
• Oversee staffing-related activities, including hiring, mentoring, performance management, corrective action, professional development, and continuing education initiatives.
• Promote team development and effectiveness by engaging with peers and leadership through knowledge sharing, training, and special projects.
• Coordinate resources cross-functionally to resolve complex issues and deliver results for partners and clients.
• Assess Clinical Operations processes for opportunities to apply AI-enabled tools, Copilot agents, automation, or workflow orchestration to reduce manual research, documentation, validation, reconciliation, and repeatable administrative work.
• Promote AI fluency across the team by supporting training, change management, adoption practices, and feedback loops that help employees use AI tools effectively and consistently.
• Champion responsible adoption of team-led agents by partnering with business, clinical, technology, AI enablement, compliance, and operational stakeholders to evaluate use cases, define success measures, and support safe implementation.
• Partner with team leads and subject matter experts to identify agent use cases that support clinical setup, drug list management, reporting, documentation, intake, issue resolution, quality review, and operational readiness.

Qualifications

Required

• Active pharmacist license required.
• Bachelor's degree in Pharmacy required; PharmD preferred.
• 5+ years of Pharmacy Benefit Management (PBM) experience preferred, including experience with clinical criteria implementation.
• First Databank experience desired.
• Proficiency working with Microsoft Excel files required.
• 7-10 years of healthcare industry experience preferred.

Preferred

• Demonstrated ability to work effectively in a highly matrixed environment.
• Strong communication, interpersonal, and collaboration skills.
• Demonstrated ability to manage multiple priorities, deadlines, and competing demands in a fast-paced environment.
• Ability to navigate and influence effectively within a complex organization.
• Ability to lead teams through systems, workflows, and processes.
• Strong negotiation, problem-solving, analytical, and decision-making skills.
• Ability to operate effectively in an environment with ambiguity.
• Ability to organize work, hold others accountable, and manage timelines.
• Digital Transformation / AI Enablement Experience:
  • Experience identifying, evaluating, or implementing automation, AI-enabled tools, workflow orchestration, or digital workforce capabilities in an operational environment.
  • Ability to translate operational pain points into practical automation or agent use cases, including defining business requirements, acceptance criteria, controls, and success metrics.
  • Working knowledge of responsible AI principles, including human oversight, data protection, governance, risk management, and change adoption.
  • Demonstrated ability to lead teams through technology-enabled process transformation while balancing innovation, quality, compliance, and operational stability.
• Experience with Agile development methodology.
• Experience managing small to mid-sized teams.
• Advanced proficiency with Microsoft Office.
• Ability to clearly document business requirements.

Work Schedule

• Standard business hours.

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an annual salary of 125,200 - 208,600 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

At The Cigna Group, you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well‑being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence. For more details on our employee benefits programs, click here.

About The Cigna Group

Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we're dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you need a reasonable accommodation to complete the online application process, please email [e-mail] for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.