Program Manager - Clinical Account Director

Gainwell Technologies; Missouri; Remote; USD 80,000 - 120,000; Full time

Job summary

An established industry player is seeking a Program Manager to lead clinical account management efforts. This remote role requires a dynamic individual with a strong background in managed care pharmacy operations. You will be responsible for ensuring client satisfaction, managing relationships with key stakeholders, and driving operational efficiencies. Your expertise in pharmacy benefit administration will be crucial in implementing strategic initiatives and improving performance metrics. This position offers the opportunity to make a significant impact in a collaborative environment while working closely with healthcare professionals and organizational leaders.

Qualifications

• 5+ years of managed care pharmacy leadership experience required.
• Strong presentation and negotiation skills are essential.

Responsibilities

• Ensure customer satisfaction and operational issues are resolved.
• Oversee business intelligence and data analytics for operations.

Skills

Managed Care Pharmacy Leadership

Presentation Skills

Negotiation Skills

Communication Skills

Project Management

Data Evaluation

Operational Efficiency Improvement

Education

Pharmacy Degree

Bachelor’s Degree

Master’s Degree in Business or Healthcare Administration

Tools

Microsoft Outlook

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

Microsoft Access

Job description

Program Manager - Clinical Account Director

Date: Apr 14, 2025

Location: Any city, MO, US, 99999

Summary

The primary responsibilities of this position are to ensure customer satisfaction, build and maintain trusting relationships with client leadership, retain clients, escalate and resolve operational issues to meet contract expectations and assure operations are aligned with organizational priorities. The position manages the relationships between all stakeholders, develops the pharmacy benefit administration (PBA) business, assures appropriate data evaluation and ensures financial viability. This role partners with the market health plan CEO and other internal business partners.

Your role in our mission

1. Serve as primary point of contact for the Missouri Single PBA
2. Provide leadership throughout the Missouri PBA including strategic and operational oversight to drive operating model performance and implement strategic initiatives
3. Ensure contract objectives and service levels are consistently met
4. Partner with leadership team and stakeholders to define top areas for selling, general and administrative expenses and cost of service improvements and implement plans to achieve desired savings
5. Oversee business intelligence across business segment to include data, analytics, and reporting requirements for new and existing operations
6. Make recommendations for improvements to meet customer expectations
7. Assure quality improvement initiatives are improving the value and cost effectiveness of PBA operations
8. Drive utilization and quality in order to maximize overall program effectiveness
9. Lead presentations to client and make routine client visits
10. May have direct reports

Qualifications

1. Pharmacy degree and MO licensure highly preferred
2. Bachelor’s degree or equivalent combination of education and experience required
3. Master’s degree in business or healthcare administration preferred
4. 5 or more years of managed care pharmacy or PBM operations leadership experience required at the director level
5. Experience with end-to-end pharmacy claims lifecycle, clinical operations, call center management, medication pricing methodologies, NCPDP standards, financial management and managed care statute
6. Experience evaluating healthcare data/outcomes is required
7. Strong presentation, negotiation, and communication skills required
8. Demonstrated leadership ability to drive results across the PBA through team influence and collaboration in a matrixed/shared service organizational model required

What we're looking for

1. Ability to manage various projects and teams simultaneously
2. Demonstrated record of improving operational efficiencies and improving financial performance
3. Excellent verbal and written skills
4. Understanding of State and Federal regulations; familiarity with the requirements of accrediting organizations
5. Capable of interacting with medical specialties staff (MDs, Nurses, Care Coordinators, etc), and Pharmacy Leadership
6. Strong acumen with establishing and monitoring clinical and business performance measures
7. Strong skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web-based applications. May produce complex documents, perform analysis, and present to senior leadership and staff

What you should expect in this role

Position is remote. Qualified candidate should reside within 100mi of Jefferson City, MO; exceptions will be considered. Position requires periodic travel.