Senior Manager Clinical Services - Express Scripts Canada

Express Scripts Canadas (ESC) Clinical Services team is responsible for the creation enhancement and maintenance of ESCs drug formularies clinical programs. 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 Senior 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 Canadas pharmacy benefit solutions and contributes to establishing strategic goals. This position will provide direction for and is responsible for the output of multiple disciplines towards ESCs formularies and clinical programs and support the clients alongside the Account Management team.

This role requires leading formulary development clinical support drug evaluation and clinical data maintenance and analysis activities. The Senior Manager Clinical Services will work closely with the Senior Manager Prior Authorization and Drug Plan Management to provide clients with pharmacy benefits solutions.

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.

Location: Mississauga Head Office

Working Environment: Hybrid 2 days a week

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. Lead the development implementation and maintenance of clinical formularies and programs.

• 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 service quality and service level agreements (SLA) are achieved; develop and monitor key performance indicators to identify process improvement system upgrades and risk management opportunities.

  • 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 clinical formularies programs etc.

  • Develop ongoing operational metrics to identify process improvement system upgrades and risk management opportunities.

  • 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:

  • Analyze 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

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

  • Champion ESCs 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 ESCs annual Outcomes conference and Drug Trend Report Drug Pipeline reports and other clinical reports

  • Acting as a clinical leader internally and externally (at industry conferences events committees professional associations client meetings etc)

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

• Providing strategic direction and sound clinical expertise to cross-functional teams for ESCs clinical products and services to enable best holistic outcomes for the clients and organization

QUALIFICATIONS:

• BS in Pharmacy; Doctor of Pharmacy required.

• Minimum 5 years of experience in PBM and/or private healthcare insurance preferred.

• Advanced clinical experience/training/certifications preferred. MBA is 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

NOTE: Internal posting will be closed on June 5 2025.