Account Management (Non-IC) Senior Associate- Hybrid - Express Scripts

The Clinical Associate Account Manager (AAM) serves as the primary liaison between the client and internal clinical operations teams, ensuring the accurate implementation and validation of pharmacy benefit designs and utilization management criteria.

This client-embedded role is responsible for triaging and resolving clinical testing issues, interpreting regulatory and policy requirements, and driving cross-functional collaboration to support compliant, high-quality member experiences.

The AAM plays a critical role in identifying systemic issues, escalating high-severity defects, and delivering insights that inform continuous improvement across clinical testing and benefit configuration processes.



* Serve as the primary clinical testing liaison for the designated client-triaging inbound questions, clarifying clinical test requirements, and driving rapid issue resolution.


* Proactively communicate clinical testing timelines, results, and remediation plans to client stakeholders; clarify benefit impacts of any clinical logic changes.


* Track daily defect tickets, test-case queues, and clinical inquiry volumes; rebalance work to maintain turnaround.


* Act as the escalation point for high-severity test defects or urgent OCEP policy questions, coordinating with Clinical Ops, IT, and Compliance to deliver root-cause fixes.


* Exercise clinical judgment to interpret PDL/UM criteria, state-specific regulations, and OCEP guidelines when recommending resolutions for complex test failures.


* Analyze test results to identify recurring clinical logic gaps, data integrity risks, and policy-compliance trends; feed insights into quarterly OCEP maintenance plans.


* Partner with ClinOps, Configuration, Pharmacy & Therapeutics, and Regulatory teams to research clinical edits and confirm accurate implementation across environments.


* Serve as subject-matter expert on the end-to-end Clinical Testing Playbook, including scenario design, benefit set up, and documentation standards.


* Lead cross-functional test-readiness huddles to ensure smooth deployment of clinical changes with minimal operational risk.


* Deliver concise clinical test-status readouts and risk dashboards to client leadership and internal governance forums.


* Function as the single point of contact for the client's clinical test workstream-post-production validation and maintenance.

Qualifications


* Bachelor's degree in a healthcare, life sciences, or related field; or 3+ years of experience in clinical operations, pharmacy benefit management (PBM), or healthcare account management.



* Minimum 3 years of experience in a client-facing or healthcare service role, with demonstrated ability to manage escalations and resolve complex clinical or operational issues.


* Working knowledge of formulary management, prior authorization criteria, and regulatory frameworks (e.g., CMS, Medicaid, OCEP).


* Strong analytical and critical think...