Clinical Domain Project Manager (PBM

The Clinical Domain Project Manager plans, coordinates, and delivers pharmacy clinical initiatives within a Medicaid, pharmacy benefit management (PBM), and healthcare payer environment. This role serves as the primary liaison between business stakeholders, clinical pharmacists, operational teams, technology teams, and external partners to ensure successful implementation of pharmacy clinical solutions and regulatory requirements. Assigned projects span drug coverage administration, Preferred Drug List (PDL) management, prior authorization, utilization management, drug utilization review, clinical criteria configuration, and pharmacy system implementations, with accountability for project governance, schedule management, stakeholder communications, risk management, and delivery of business outcomes.

This is a fully remote, full time engagement with an anticipated duration of ten months and an immediate start. No travel is required, and a background check must be successfully completed prior to onboarding.

Must be eligible to work in the United States. No sponsor ships are available at this time.

• Leads pharmacy clinical projects through initiation, planning, execution, monitoring, and closure
• Develops and maintains integrated project plans, schedules, milestones, dependencies, and deliverables
• Facilitates requirements gathering, design reviews, solution validation, testing, and implementation activities
• Coordinates cross-functional teams across clinical, operational, technical, and business work streams
• Manages project budgets, scope, schedule, risks, issues, assumptions, and dependencies
• Supports implementation and enhancement of drug coverage administration, Preferred Drug List (PDL) management, prior authorization (PA) programs, electronic prior authorization (ePA), and drug utilization review (DUR)
• Ensures clinical program requirements are accurately translated into system and operational solutions

• Serves as primary point of contact for client, clinical, and internal project stakeholders
• Facilitates decision-making discussions and executive governance meetings
• Communicates project status, risks, issues, and mitigation strategies to leadership
• Builds collaborative relationships with pharmacy directors, clinical pharmacists, business analysts, product teams, and external vendors

• Ensures project deliverables comply with federal and state Medicaid requirements
• Supports readiness for audits, regulatory reviews, and contractual reporting obligations
• Coordinates implementation efforts involving the Centers for Medicare and Medicaid Services (CMS), Medicaid agencies, pharmacy benefit managers (PBMs), and healthcare partners as applicable
• Maintains traceability between business requirements, design decisions, testing results, and implemented solutions

• Coordinates activities with PBMs, pharmacy system vendors, clinical review organizations, and state stakeholders
• Manages integration and dependency tracking across external partners
• Facilitates issue resolution and escalation management to meet project objectives

• Leads implementation readiness reviews and go-live planning activities
• Coordinates training, deployment, cutover, and stabilization efforts
• Develops implementation plans, communication strategies, and transition-to-operations procedures
• Supports continuous improvement initiatives and lessons-learned activities

• Demonstrated success leading large-scale healthcare or pharmacy benefit management (PBM) implementations
• Experience managing multiple work streams and vendors simultaneously
• Experience leading end-to-end lifecycle activities from project startup through post go-live support
• Experience with Preferred Drug List (PDL) administration
• Experience with prior authorization (PA) programs
• Experience with electronic prior authorization (ePA) and drug utilization review (DUR)
• Experience with clinical policy administration and utilization management initiatives
• Expert-level schedule performance management using Microsoft Project
• Deliverable…