Vice President – PBM Management

This is a fully remote position, open to applicants in United States.

📋 Description

• Take charge of the pharmacy strategy for Medicare Advantage within the health plan.

• Oversee Clover's partnership with its Pharmacy Benefit Manager (PBM), ensuring optimal contract performance, service standards, cost management, and adherence to contractual obligations.

• Formulate a strategy for the formulary that balances clinical quality, member satisfaction, and financial success.

• Guarantee compliance with PBM contracts while overseeing vendor agreements and adhering to CMS requirements.

• Discover opportunities for managing macro pharmacy expenditures.

• Assemble and lead a team of pharmacy professionals to manage key PBM and vendor relationships.

• Collaborate with Finance on predicting outcomes, rebate strategies, and pharmacy economics.

• Work closely with Clinical Care Services, Network, Legal, and Product leaders to enhance PBM performance and financial results.

• Contribute to enterprise Part D Stars initiatives through effective PBM execution, fulfilling contractual obligations, and making formulary choices.

• Offer executive insights on new pharmacy regulations, market trends, and strategic opportunities.

• Spot areas for enhancing quality, affordability, and financial outcomes across PBM contracts.

• Cultivate relationships with executives and PBM partners, evaluate performance and compliance, and create a long-term pharmacy strategy.

• Execute enhancements in PBM governance and performance management.

• Establish operating rhythms across pharmacy strategy, finance, legal, and care management teams.

⛳️ Requirements

• Proven experience in leading pharmacy strategy within a Medicare Advantage plan or a similarly intricate payer environment.

• Extensive experience in managing PBMs and pharmacy vendors.

• Strong understanding of formulary management, enforcement of PBM contracts, CMS regulations, and pharmacy economics.

• Capability to balance clinical quality, member experience, and financial performance effectively.

• Confidence in influencing executives and navigating contract negotiations and enforcement details.

• Experience in building organizations and leading through influence within highly matrixed teams.

🏝️ Benefits

• Competitive base salary.

• Equity opportunities.

• Performance-based bonus program.

• 401(k) matching.

• Regular compensation reviews.

• Comprehensive medical, dental, and vision coverage.

• No-Meeting Fridays.

• Monthly company holidays.

• Mental health resources.

• Generous flexible time-off policy.

• Remote-first culture.

• Learning programs.

• Mentorship.

• Professional development funding.

• Regular performance feedback and reviews.

• Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities.

• Reimbursement for office setup expenses.

• Monthly cell phone & internet stipend.

• Collaboration with global teams.

• Paid parental leave for all new parents.