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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.
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.
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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.
Digital Transformation / AI Enablement Experience: 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 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 teams.
Advanced proficiency with Microsoft Office.
Ability to clearly document business requirements.
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.
A global health company committed to improving health and vitality.
Visit company websiteJobs and hiring trendsUSD 125200-208600 yearly / year
Full-time
Senior · 5+ years experience
Remote
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