Vice President – PBM Management

🔥 12 hours ago

🇺🇸 United States – Remote

💵 $278k - $320k / year

⏰ Full Time

🔴 Lead

👔 Vice President

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Clover Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

🏥 Healthcare

🛡️ Insurance

🤖 Artificial Intelligence

Healthcare • Insurance • Artificial Intelligence

Clover Health is a healthcare technology company helping members live their healthiest lives with our Medicare Advantage plans. Focused on seniors who have historically lacked access to affordable and high-quality healthcare, Clover aims to provide care sustainably by improving medical outcomes while simultaneously lowering avoidable costs. They leverage a proprietary software platform, the Clover Assistant, to aggregate patient data and offer real-time recommendations to healthcare providers. Their services include affordable Medicare Advantage plans, a home care program, and they manage care for Medicare Advantage members across several U. S. states.

📋 Description

• Own the Medicare Advantage pharmacy strategy across the health plan • Lead Clover's relationship with its PBM, including contract performance, service levels, cost management, and contractual adherence • Develop formulary strategy balancing clinical quality, member experience, and financial performance • Ensure PBM contractual compliance and oversight across vendor agreements and CMS requirements • Identify macro pharmacy spend management opportunities • Build and lead a team of pharmacy associates managing critical PBM and vendor relationships • Partner with Finance on forecasting, rebate strategy, and pharmacy economics • Partner with Clinical Care Services, Network, Legal, and Product leaders to maximize PBM performance and financial outcomes • Support enterprise Part D Stars initiatives through PBM execution, contractual fulfillment, and formulary decisions • Provide executive recommendations on emerging pharmacy regulations, market dynamics, and strategic opportunities • Identify opportunities to improve quality, affordability, and financial performance across PBM contracts • Build executive and PBM partner relationships, assess performance and compliance, and develop a multi-year pharmacy strategy • Implement improvements in PBM governance and performance management • Establish operating rhythms across pharmacy strategy, finance, legal, and care management teams

🎯 Requirements

• Experience leading pharmacy strategy inside a Medicare Advantage plan or similarly complex payer • Deep experience managing PBMs and pharmacy vendors • Understanding of formulary management, PBM contract enforcement, CMS regulations, and pharmacy economics • Ability to balance clinical quality, member experience, and financial performance • Comfort influencing executives and driving contract negotiation and enforcement details • Experience building organizations and leading through influence across 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