Manager, Clinical Program Pharmacy

Summary

The Manager, Clinical Program - Pharmacy supports the Vice President, Pharmacy Services by providing leadership, strategic direction, and operational oversight for the Pharmacy program. This role is responsible for people leadership, program performance, client engagement, workforce planning, and continuous improvement initiatives while ensuring high-quality pharmacy services and optimal member outcomes.

The Manager provides leadership and guidance to Pharmacy Leads and clinical staff and serves as the primary escalation point for complex clinical, operational, and client-related issues.

Responsibilities

People & Culture

• Support recruiting and retention efforts, including participation in new hire selection.
• Provide direct leadership and management of pharmacists, nurses, and support staff.
• Develop Pharmacy Leads and other leadership-level team members while ensuring consistent application of coaching frameworks across the department.
• Deliver performance feedback and provide performance management and coaching to support employee development and maximize team success.
• Foster a collaborative, community-oriented culture that recognizes and rewards innovation, enhancing both member and employee satisfaction.
• Establish onboarding, training, competency, and quality standards for the Pharmacy program and ensure Pharmacy Leads execute development plans consistently across teams.
• Conduct regular one-on-one meetings and quarterly performance reviews with assigned staff, utilizing data and insights provided by the Clinical Quality team.
• Lead succession planning and Individual Development Plan (IDP) processes to support professional growth and identify high-potential talent.
• Oversee workforce planning, service levels, productivity targets, and resource allocation across the Pharmacy program.
• Facilitate department-wide communications, strategic planning sessions, leadership meetings, and organizational initiatives impacting Pharmacy Services.
• Promote a culture of camaraderie, partnership, and collaboration.
• Ensure accountability and shared responsibility for delivering high-quality member and provider support.

Client Experience

• Build and maintain effective client relationships while ensuring alignment with client expectations.
• Collaborate with external plan partners, including Third-Party Administrators (TPAs), Pharmacy Benefit Managers (PBMs), and vendor partners, to support client plans and address member concerns.
• Identify and resolve issues to maintain exceptional client and member service, escalating trends and risks to leadership as appropriate.
• Partner with organizational leadership to support successful client implementations and keep Client Executives informed of emerging issues and trends.
• Participate as a clinical leader during prospective and current client meetings and site visits.
• Provide clinical consultation and support to Pod Leadership and Client Engagement Group (CEG) teams for escalated client cases.
• Serve as the primary clinical representative during advocacy reviews and clinical audits by:
  • Presenting audit materials and findings.
  • Responding to stakeholder questions.
  • Identifying and summarizing key themes and improvement opportunities.
  • Collaborating with Clinical Quality & Accreditation, Clinical Training, Clinical Program Leadership, Clinical Delivery Leadership, and Pod Leadership teams.

Clinical Leadership & Subject Matter Expertise

• Reinforce expectations related to workflows, processes, protocols, and program design.
• Serve as an accessible resource for staff, answering questions and clarifying expectations.
• Assist with resolution of escalated issues and complex clinical or operational challenges.
• Communicate client expectations, business performance metrics, member satisfaction insights, and team culture initiatives.
• Support specialty clinical teams by:
  • Triaging Patient Service Representative (PSR) inquiries.
  • Providing clinical guidance and consultation.
  • Reviewing and resolving clinical questions or delegating as appropriate.
  • Serving as a clinical resource for leaders and specialty team staff.
• Monitor and adjust daily clinical workloads to ensure operational effectiveness.
• Maintain a comprehensive understanding of clinical workflows, policies, and procedures.
• Support team members in resolving issues, obtaining necessary information, and improving the overall member healthcare experience.

Qualifications

Licensure & Credentialing

• Must hold an active, unrestricted, and unencumbered professional license in good standing with the applicable state licensing board in one of the following disciplines:

  • Registered Nurse (RN)
  • Licensed Clinical Social Worker (LCSW)
  • Licensed Professional Counselor (LPC)
  • Pharmacist (R.Ph. or PharmD)
  • Other independently licensed healthcare professional authorized to conduct clinical assessments

• Where applicable, clinicians must maintain a Multi-State License (MSL) issued through the appropriate licensure compact (for example, the Nurse Licensure Compact for RNs).

• For clinicians residing in states that do not offer an MSL, or disciplines without an established multistate licensure program, individuals must be willing and able to obtain and maintain additional state licenses as required to support members served by the organization.

• All required licenses, including MSLs and additional state licenses, must be obtained within 90 days of hire.

• Ongoing maintenance, timely renewal, and compliance with all licensure requirements and state board regulations are conditions of employment.

Education, Skills & Experience

Required

• Doctor of Pharmacy (PharmD).
• Minimum of 5 years of pharmacy experience.
• Minimum of 3 years of pharmacy leadership, management, or supervisory experience.

Preferred

• 3 to 5 years of experience managing a pharmacy team.
• Experience mentoring, coaching, and developing clinical professionals in a healthcare environment.

Knowledge & Skills

• Expertise in:

  • Managed care
  • Specialty pharmacy
  • Utilization management
  • Pharmacy Benefit Manager (PBM) operations
  • Performance coaching
  • Analytics and reporting
  • Client relationship management

• Excellent verbal, written, and presentation communication skills.

• Proven ability to drive results in a high-service healthcare, insurance, or managed care environment.

• Strong leadership, organizational, and workforce planning skills.

• Knowledge of interdisciplinary clinical operations and healthcare delivery models.

• Ability to analyze operational performance and implement continuous improvement initiatives.

• Commitment to protecting confidential company and member information and operating in accordance with organizational ethics, compliance standards, and data security policies.

Key Competencies

• Strategic Leadership
• People Development & Coaching
• Client Relationship Management
• Pharmacy Operations Management
• Workforce Planning
• Clinical Expertise
• Performance Management
• Process Improvement
• Quality & Compliance
• Communication & Collaboration
• Problem Solving & Decision Making
• Member-Centered Service Excellence