Manager, Clinical Services

Express Scripts Canada's (ESC) Clinical Services team is responsible for the creation, enhancement and maintenance of ESC's drug formularies and clinical programs. The Manager, Clinical Services reports to the Director, Clinical Services and is responsible for the successful management of all clinical activities related to the development and maintenance of Express Scripts Canada's pharmacy benefit solutions and contributes to establishing strategic goals. The Manager, Clinical Services will work closely with the Senior Manager, Prior Authorization and Drug Plan Management to ensure clients' needs are met.

This role is responsible for leading formulary development, clinical support, drug evaluation, and data analysis activities. The responsibilities for this position will include, but not limited to: (1) lead the development, implementation, and maintenance of clinical formularies and programs; (2) champion ESC's Drug Evaluation Committee (DEC) and Validation (VAL) meetings; (3) lead the development and delivery of ESC's annual Outcomes conference and Drug Trend Report; and (4) provide strategic direction and sound clinical expertise to cross-functional committees for ESC's clinical products and services.

The responsibilities for this position will include, but are not limited to:

• Leading the development, implementation, and maintenance of clinical formularies and programs

• Ensuring service quality and service level agreements (SLA) and objectives (SLO) are achieved; developing and monitoring key performance indicators to identify process improvement, system upgrades and risk management opportunities

• Analyzing drug claims data with a clinical view to provide valuable and actionable insights to clients, to present relevant trends to PBM industry and to derive meaningful information for customers

• Providing sound clinical expertise to cross-functional teams for ESC's clinical products and services

• Leading and providing growth development opportunities to the Clinical pharmacist team

• Supporting and contributing to the strategic direction of Clinical Services

• Acquiring and maintaining detailed knowledge of existing products and their features and will assist with customer product inquiries, sales presentations, and requests for proposals

• Acting as Clinical Services business leader on ESC committees and working groups

• Promoting Clinical Services to existing and new clients to align with strategic objectives of ESC

This position has ownership for managing performance and metrics, workflow management, departmental standard measurements and core client service delivery. Responsibilities include directing operations, creating, executing and managing on procedures and resolution of customer complaints and inquiries. This leader utilizes in-depth professional knowledge, guided by functional practices to implement and execute best practice strategies within the Clinical team.

Essential Functions

Vision and Strategy: Develop vision and strategy for the Clinical Services team, including both, short-term and long-term goals, that align with corporate strategic direction.

Leadership: Lead and engage teams in achieving strategic goals/objectives, developing and implementing initiatives that meet the goals, maximizing outcomes. Foster a growth-oriented culture though coaching and mentoring to expend team proficiency, skill development and cross training to create bench strength and alignment with corporate goals.

Workflow Management: Develop and maintain monitors and controls to maximize ability to meet service standards and objectives for turnaround time and quality

• Ensure that all contractual, service quality and service level agreements (SLAs) are achieved

• Oversee operational processes and support process improvements, efficiencies and automation to optimize results

• Ensures teams to create and update documentation for day-to-day operations, drug assessment, clinical formularies and programs

• Develop ongoing operational metrics to monitor work conducted by the team in support of our clients and ensure visibility on status of service delivery along with insights on trends

• Develop, monitor and assess key performance indicators to support data driven decisions in mitigating risk and exploring opportunities to streamline, automate and improve existing service delivery

Clinical Services Management:

• Lead the clinical pharmacists in development, maintenance and enhancement of clinical formularies and programs

  • Champion ESC's Drug Evaluation Committee (DEC) and Validation (VAL) meetings to review new drugs and new indications. Track and provide ESC and clients with industry knowledge, including legislative updates (national and provincial), drug pipeline tracking, etc.

    • Serve as a member of the Value Assessment Committee (VAC) to ensure decisions are aligned with formularies and clinical programs while supporting the operationalization of VAC recommendations

    • Support the creation and enhancement of Products with Clinical Services expertise

    • Lead the development and delivery of ESC's annual Outcomes conference and Drug Trend Report, Drug Pipeline reports, and other clinical reports

Resource Management: Foster a people first culture that develops the skills and capabilities of team members to enable personal and business growth

Collaboration: Work cross functionally with ESC teams to enable best holistic outcomes for the clients and organization

Qualifications:

• BS in Pharmacy; Doctor of Pharmacy required. MBA is preferred.

• Drug evaluation experience is preferred

• Minimum 3 years of experience in PBM and/or private healthcare insurance preferred.

• Advanced clinical experience/training/certifications preferred.

• License to practice pharmacy in Canada

• Strong analytical skills to derive meaningful insights for ESC, Clients and PBM

• Strong organizational, communication (written, oral, and presentation) and PC skills including advanced research and analytical skills

• Excellent written and verbal communication skills to convey complex concepts to technical and non-technical audiences

• Ability to collaborate effectively in team environment and effectively manage multiple projects simultaneously. Excels at fostering cross functional teamwork and partnerships

• Resourcefulness skills required; Identify challenges that may occur and address potential solutions with your team to prevent or minimize obstacles before they arise

• Self-starter able to work in a dynamic, fast paced environment and make independent decisions

• Proven skills in time management, planning, prioritization, change management and employee performance management

• Strong client service focus through adaptability, flexibility and a commitment to quality

• Bilingual; Fluent in French and English (verbal and written) is an asset

*Internal application deadline: March 5, 2025*

Express Scripts Canada is a Cigna company

Express Scripts Canada is a subsidiary of Express Scripts, a Cigna company. Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, wellbeing and peace of mind of those we serve. Cigna offers an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioural health, pharmacy, vision, supplemental benefits, and other related products.

About Express Scripts Canada

Express Scripts Canada is a leading health benefits manager and has been recognized as one of the most innovative. Our clients include Canada's leading insurers, third party administrators and governments. We work with these clients to develop industry-leading solutions to deliver superior healthcare in a cost-controlled environment. We provide Active Pharmacy services to more than 7 million Canadian patients and adjudicate more than 100 million pharmacy, dental, and extended health claims annually. Through our proprietary consumer intelligence, clinical expertise, and patients-first approach, we promote better health decisions for plan members, while managing and reducing drug benefit costs for plan sponsors.

It will be a condition of employment that the successful candidate obtains an Enhanced Reliability Clearance from the Federal Government. The candidate will be required to provide supporting documentation to receive clearance if required.

We offer a competitive salary and benefits package, along with a positive work environment built on solid corporate values, integrity, mutual respect, collaboration, passion, service and alignment.

We are an equal opportunity employer that promotes a diverse, inclusive and accessible workplace. By embracing diversity, we build a more effective organization that empowers our employees to be the best that they can be.

We are committed to creating a working environment that is barrier-free and we are prepared to provide accommodation for people with disabilities.

If you require accommodation in completing the online application process, please email: eschr2@express-scripts.com Do not email eschr2@express-scripts.com for an update on your application or to provide your resume as you will not receive a response.