Vice President, PBM Management

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Vice President, PBM Management based in United States.

This executive role owns the pharmacy strategy supporting a Medicare Advantage health plan, with responsibility for PBM performance, economics, formulary strategy, and vendor relationships. You will shape a pharmacy strategy that balances affordability, clinical quality, member experience, and long-term financial performance. The position combines strategic leadership with hands-on oversight of PBM contracts, compliance, financial optimization, and pharmacy operations. Reporting to the CEO of the Medicare Advantage business, you will work closely with senior leaders across Finance, Clinical Care, Network, Legal, Product, and other functions. You will also build and lead a pharmacy team while establishing strong governance and accountability across critical external partnerships. This is a high-impact opportunity to influence enterprise strategy within a technology-enabled, data-driven healthcare environment.

\n

Accountabilities:

• Own the overall Medicare Advantage pharmacy strategy, aligning PBM management and pharmacy initiatives with broader health plan objectives.
• Lead the primary PBM relationship, driving contractual performance, service levels, cost management, financial outcomes, and adherence to contractual obligations.
• Develop and execute formulary strategies that balance clinical quality, member experience, affordability, and financial performance.
• Oversee PBM contractual compliance, vendor performance, and adherence to applicable CMS requirements.
• Identify and execute opportunities for pharmacy spend management, financial optimization, and improved value across PBM arrangements.
• Build, lead, and develop a pharmacy team responsible for supporting critical PBM and vendor relationships and strategic initiatives.
• Partner with Finance on pharmacy forecasting, rebate strategy, financial modeling, and pharmacy economics.
• Collaborate with Clinical Care Services, Network, Legal, Product, and other cross-functional leaders to improve PBM performance and financial outcomes.
• Support Part D Stars initiatives by ensuring PBM execution, contractual fulfillment, and formulary decisions contribute to program objectives.
• Establish strong governance, operating rhythms, performance measurement, and accountability across pharmacy strategy and internal stakeholder teams.
• Monitor emerging pharmacy regulations, market dynamics, industry developments, and strategic opportunities, providing clear recommendations to executive leadership.
• Continuously evaluate PBM contracts, pharmacy programs, and operating practices to identify opportunities to improve quality, affordability, and financial performance.
• Build trusted relationships with executive stakeholders and external PBM partners while effectively influencing highly matrixed teams.

Requirements:

• Significant experience leading pharmacy strategy within a Medicare Advantage plan or similarly complex health insurance or payer environment.
• Deep experience managing PBMs and pharmacy vendors, including contract oversight, performance management, and relationship leadership.
• Strong understanding of formulary management, PBM contract enforcement, CMS requirements, pharmacy economics, and pharmacy spend management.
• Demonstrated ability to balance clinical quality, member experience, affordability, and financial performance when developing pharmacy strategies.
• Executive-level communication and influence skills, with the ability to present strategic recommendations clearly and work effectively with senior leadership.
• Strong experience negotiating, managing, and enforcing complex contracts and translating contractual requirements into measurable operational performance.
• Proven ability to work across Finance, Clinical, Network, Legal, Product, and other highly matrixed functions to drive shared outcomes.
• Experience building, leading, mentoring, and developing high-performing teams.
• Strong analytical and financial acumen, with the ability to evaluate pharmacy economics, forecasts, rebates, performance metrics, and investment opportunities.
• Comfortable operating strategically while remaining close to operational and contractual details.
• Strong judgment and ability to navigate ambiguity, changing regulations, market dynamics, and competing priorities.
• Entrepreneurial, collaborative, and execution-oriented approach with a demonstrated ability to build organizations and establish effective operating processes.

Benefits:

• Base salary range of $278,000–$320,000 USD.
• Equity opportunities.
• Performance-based bonus program.
• 401(k) plan with employer matching.
• Regular compensation reviews.
• Comprehensive medical, dental, and vision coverage.
• Flexible time-off policy.
• Paid parental leave for all new parents.
• Employee Stock Purchase Plan (ESPP) with discounted equity opportunities.
• Office setup expense reimbursement.
• Monthly cell phone and internet stipend.
• Mental health resources and wellness support.
• No-Meeting Fridays and monthly company holidays.
• Learning programs, mentorship, professional development funding, and regular performance feedback.
• Remote-first work environment with flexibility to collaborate across locations.
• Opportunity to influence pharmacy strategy, PBM performance, and healthcare affordability at an executive level.

\n

How Jobgether works:

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

 Why Apply Through Jobgether? 

Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

#LI-CL1