Clinical Program Manager - Evernorth - Remote (Clinical Operations Support & Custom Services)

Location: United States Work at Home

Remote Type: Remote

Time Type: Full time

Job Description

The Clinical Program Manager, Custom Implementation & Operations Support Services, leads Clinical Program Advisors and analysts supporting clinical program operations, custom client implementations, specialty programs, analyst services, and operational process improvements. This leader partners across clinical, implementation, product, technology, business, and Global Service Partners to translate requirements into accurate, timely, and sustainable operational solutions.

 

The role provides strategic and day-to-day leadership across custom client support, specialty program implementation, operational governance, data quality, process optimization, and ongoing pharmacy benefit and clinical configuration activities.

 

Primary Responsibilities

 

• Lead, coach, and develop clinical operations analysts and support resources.

• Oversee Clinical Operations Support Services, Specialty, Analyst Support Services, and Custom Support Services activities.

• Manage operational support for specialty programs, Pathwell, preventive programs, and other high-maintenance clinical initiatives.

• Lead the development of new operational processes for products and projects, establish sustainable maintenance models, and transition ongoing ownership to the appropriate operational teams.

• Partner with matrix stakeholders to gather requirements, assess operational impacts, and develop implementation approaches.

• Drive continuous improvement by identifying and leveraging automation and AI solutions to enhance team efficiency, data quality, workflow optimization, and operational scalability.

• Oversee and support Rx Configuration PBAB requests responsible for exception review, consultation, risk and feasibility assessment.

• Ensure accurate and timely execution of 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 to support new 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 while building team capabilities and reducing key-person dependencies.

• Foster a culture of collaboration, accountability, adaptability, innovation, and continuous improvement.

 

Required Qualifications

 

• Pharmacy degree (BSPharm or PharmD) and an 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 existing high-level-of-effort products and the operational processes required to maintain them.

• Two or more years of leadership or people-management experience.

• Demonstrated 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 stakeholders across business, operational, and technical organizations.

• Proficiency with Microsoft Office, including Excel and PowerPoint.

 

Preferred Qualifications

 

• Experience in pharmacy benefit management, formulary management, utilization management, or clinical configuration.

• Experience supporting specialty pharmacy programs and custom client implementations.

• Knowledge of DCRS, CRS, FRS, Polaris, FIT, or related clinical configuration systems.

• Experience working with offshore or geographically distributed teams.

• Pharmacy, healthcare operations, or clinical program management background.

 

The Clinical Program Manager, Custom Implementation & Operations Support Services, leads Clinical Program Advisors and analysts supporting clinical program operations, custom client implementations, specialty programs, analyst services, and operational process improvements. This leader partners across clinical, implementation, product, technology, business, and Global Service Partners to translate requirements into accurate, timely, and sustainable operational solutions.

The role provides strategic and day-to-day leadership across custom client support, specialty program implementation, operational governance, data quality, process optimization, and ongoing pharmacy benefit and clinical configuration activities.

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 106,000 - 176,600 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 seeyourself@thecignagroup.com 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.