Senior Manager PA and DPM

Job Title: Senior Manager PA and DPM contract

Location: Mississauga, ON

Employment Type: Contract

Reason for Vacancy: Replacement – interim assignment

Work Arrangement: Hybrid

Department Name: Pay Type: Hourly Pay Range: $60.00 to $65.00. Please note that this is a general posting range and offer range will be varied based on relevant experience, qualifications, skills required and location for this role.

About Us:

Express Scripts Canada (ESC) is a leading health benefits management company. Serving over 12 million members, we help insurance carriers, third party administrators, and the public sector optimize the value of health benefits by linking the talent and professional expertise of our people with leading edge information management systems and technology. ESC is a wholly owned subsidiary of Express Scripts Inc., one of the largest pharmacy benefit management (PBM) companies in North America, part of The Cigna Group (NYSE: CI), a global health company. Together, we deliver innovative, cost-effective solutions that improve access, affordability, and health outcomes for Canadians.

Job Summary:

Express Scripts Canada’s (ESC) Clinical Services team is responsible for the creation, enhancement and maintenance of ESC’s drug formularies, clinical programs and healthcare technology databases (drug, health and dental). The Clinical Services team works closely with the Account Management team to support clients’ PBM needs and provides clinical input on any organizational projects or initiatives requiring clinical knowledge. The Manager, Prior Authorization (PA) and Drug Plan Management (DPM) will report to the Director, Clinical Services and be responsible for leading and executing strategies pertaining to Prior Authorization and drug plan management services. As part of the Clinical Services department, this position will also serve as a clinical advisor to the organization and provide leadership to ESC to ensure innovation amongst a competitive landscape. This position carries accountability for service delivery and SLA performance while driving transformative and sustainable initiatives aimed at improving client-facing service offering and modernization. Responsibilities include directing operations, creating, executing and managing procedures and resolution of customer complaints and inquiries.

Key Responsibilities:

• Leadership & Management Lead the PA and DPM teams in delivering annual strategic objectives, with progress monitored through defined milestones, service-level performance, quality measures and project outcomes.
• Foster a growth-oriented culture through coaching and mentoring to expand team proficiency, skill development and cross training to create bench strength and alignment with corporate goals.
• Lead change-management activities by assessing operational impacts, documenting key risks and mitigation plans, and monitoring implementation progress to support timely adoption.
• Strategy Partner with the Director to define the vision and strategy for the PA and DPM teams and translate priorities into a documented roadmap with owners, milestones, timelines and success measures.
• Provide strategic direction and clinical expertise to guide the implementation, communication, education and maintenance of ESC’s Prior Authorization program
• Operations Own end-to-end delivery of PA and DPM operations, ensuring SLAs and quality standards are consistently met across clients.
• Develop ongoing operational metrics and performance indicators to monitor performance, workload and productivity and ensure visibility on status of service and trends.
• Identify, prioritize and implement process improvements that reduce manual or low-value work, increase team capacity and expand the volume or scope of services delivered; track results using agreed efficiency, quality and capacity measures.
• Oversee the onboarding of new clients for Prior Authorization program and support post-implementation activities.
• Serve as the subject matter expert for complex internal and external requests; review clinical and plan information, make or recommend coverage decisions within delegated authority and applicable guidelines, and document and communicate the rationale to relevant stakeholders.

What We’re Looking For:

• BS in Pharmacy or Doctor of Pharmacy required
• Licensed to practice pharmacy in Canada required
• Minimum five years of experience in pharmacy benefit management, private healthcare insurance, drug plan management or a related field is preferred.
• 3 years of progressive leadership experience, including team management, coaching, performance management and operation oversight.
• Advanced clinical training or a relevant certification is preferred; an MBA or comparable graduate-level business qualification is an asset.
• Demonstrat