Vice President, PBM Management
Core
Lead pharmacy strategy and PBM management for a Medicare Advantage plan, optimizing formulary, contracts, and financial performance to improve member outcomes and plan profitability.
Role type
Executive Vice President, PBM Management
Builds
Medicare Advantage pharmacy strategy, PBM partnerships, and formulary management
Domain
Healthcare Insurance / Medicare Advantage / Pharmacy Benefit Management
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
PBM partnership management, formulary strategy, contract enforcement, pharmacy economics, CMS regulation compliance, executive leadership, team building, financial forecasting, rebate strategy
Preferred skills
Experience in complex payer environments, matrixed team leadership, strategic planning, stakeholder influence
Technologies
Clover Assistant
Responsibilities
Own Medicare Advantage pharmacy strategy; lead PBM relationship and contract performance; develop formulary strategy balancing quality and cost; ensure CMS and contractual compliance; manage macro pharmacy spend; build and lead pharmacy team; partner with Finance, Clinical, Legal, and Product leaders; support Part D Stars initiatives; provide executive recommendations on regulations and market dynamics.
Seniority
Executive, C-suite level