Vice President, PBM Management
Core
Own the pharmacy strategy for a Medicare Advantage health plan, balancing affordability, clinical quality, member experience, and financial performance through PBM management and vendor relationships.
Role type
Executive Vice President, Pharmacy Strategy & PBM Management
Builds
Enterprise pharmacy strategy, PBM contracts, formulary programs, and governance frameworks for a Medicare Advantage plan
Domain
US Healthcare / Medicare Advantage / Pharmacy Benefit Management
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
PBM contract negotiation and performance management, formulary strategy development, pharmacy economics and spend optimization, CMS regulatory compliance, executive stakeholder influence, cross-functional leadership (Finance, Clinical, Legal, Product), team building and mentoring, financial forecasting and modeling, strategic planning in complex payer environments
Preferred skills
Experience in technology-enabled healthcare environments, deep knowledge of Part D Stars initiatives, ability to navigate ambiguity and changing regulations
Technologies
None stated
Responsibilities
Own the overall Medicare Advantage pharmacy strategy aligning with health plan objectives; Lead the primary PBM relationship driving contractual performance and cost management; Develop and execute formulary strategies balancing clinical quality and affordability; Oversee PBM contractual compliance and vendor performance; Identify opportunities for pharmacy spend management and financial optimization; Build and lead a pharmacy team supporting critical initiatives; Partner with Finance on forecasting, rebate strategy, and financial modeling; Collaborate with Clinical Care, Network, Legal, and Product leaders to improve outcomes; Support Part D Stars initiatives; Establish governance and performance measurement; Monitor emerging regulations and market dynamics; Continuously evaluate contracts and practices to improve quality and performance; Build trusted relationships with executive stakeholders and external partners
Seniority
Executive (VP level), strategic leadership with hands-on oversight