Clinical Project Manager, Pharmacy Benefit Management
Overview
Own delivery of pharmacy clinical initiatives in a Medicaid PBM environment. You will lead projects from drug coverage administration to PDL management and prior authorization programs, coordinating cross-functional teams. Work fully remote with stakeholders including pharmacy directors, clinical pharmacists, technology teams, and external vendors. This contract role runs 10 months with immediate start, no travel, and a background check required. You will shape solutions that meet strict regulatory requirements and improve member outcomes.
What You'll Do10
- 1Lead pharmacy clinical projects through initiation, planning, execution, monitoring, and closure, using PMBOK principles.
- 2Build and maintain integrated project plans with schedules, milestones, dependencies, and deliverables in Microsoft Project.
- 3Coordinate requirements gathering, design reviews, solution validation, testing, and implementation across clinical, operational, technical, and business workstreams.
- 4Drive implementation of PDL management, PA programs, ePA, and DUR to meet clinical and regulatory goals.
- 5Serve as primary point of contact for client, clinical, and internal stakeholders, facilitating governance meetings and decision-making.
- 6Manage project budgets, scope, schedule, risks, issues, assumptions, dependencies, and RAID logs.
- 7Ensure project deliverables comply with federal and state Medicaid requirements and support audit readiness.
- 8Coordinate with PBMs, pharmacy system vendors, and state stakeholders to track integrations and resolve escalations.
- 9Lead go-live planning, training, deployment, and stabilization, plus transition-to-operations procedures.
- 10Support continuous improvement by capturing lessons learned and refining project processes.
Requirements10
- 17+ years of project management experience, including large-scale healthcare or PBM implementations.
- 27+ years supporting Medicaid PBM programs with expertise in PDL administration.
- 3Experience with prior authorization programs, including ePA and DUR.
- 4Expert-level schedule management using Microsoft Project.
- 5Demonstrated success managing multiple workstreams and vendors simultaneously.
- 6Experience with clinical policy administration and utilization management initiatives.
- 7Strong RAID management and deliverable oversight, including Medicaid deliverables.
- 8Cross-domain coordination across claims, provider, member, clinical, rebate, and portal functions.
- 9PMP certification preferred, not required.
- 10Eligibility to work in the United States without sponsorship.
Salary Insight
Salary not disclosed in listing
Location
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