Clinical Program Sr. Manager - Express Scripts - Remote

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.

• 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, partnership with technical and business leads to develop, maintain, and enhance clinical implementation management processes, and 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.

• 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.
• 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.
• 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…