Vice President, Pharmacy Networks

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SmithRx

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2018

💼 Consulting

🛡️ Insurance

🏥 Healthcare

💰 $20M Series B on 2022-03

Consulting • Insurance • Healthcare

SmithRx is a transparent, pass-through pharmacy benefits manager (PBM) that operates independently from insurance companies and pharmacies to align its incentives with self-insured employers and their members. By leveraging modern technology, SmithRx aims to reduce the cost and complexity of pharmacy benefits, ensuring the delivery of effective and low-cost drugs. The company is dedicated to transforming the pharmacy benefits landscape through its flat-rate, transparent pricing model and innovative cost savings programs, which connect members to the lowest cost drugs without the use of spread pricing, rebates, or other tactics. SmithRx's commitment to transparency and superior customer service results in significant savings for employers and a highly satisfactory experience for its members.

📋 Description

• Lead Network Strategy: Design and execute the overarching strategy for SmithRx’s national and custom pharmacy networks, ensuring alignment with our transparent business model and client needs. • Contract Negotiation: Lead high-level negotiations with major retail chains, PSAOs, specialty pharmacies, and mail-order partners to secure competitive reimbursement rates and favorable contract terms without relying on spread pricing. • Identify and develop innovative network programs (e.g., high-performance or narrow networks, direct-to-consumer delivery models) to drive down drug costs and improve member access. • Monitor and manage the ongoing performance of the pharmacy network against defined SLAs, ensuring adherence to contractual terms, quality standards, and pricing accuracy. • Direct the credentialing and re-credentialing processes, ensuring all network pharmacies comply with federal, state, and SmithRx regulatory standards. • Oversee the pharmacy audit team to manage network integrity, minimize Fraud, Waste, and Abuse (FWA), and execute audit recoveries effectively. • Implementation of needed policies and procedures to meet CMS oversight requirements. • Partner closely with Sales, Customer Success, Clinical Strategy, Pricing/Underwriting, and Product teams to ensure network capabilities are accurately represented in the market and successfully integrated into our technology platforms. • Collaborate with data and analytics teams to monitor network profitability, utilization trends, and cost models to proactively identify areas for financial optimization. • Build, mentor, and scale a high-performing team of network managers, contracting specialists, and analysts. Foster a culture of accountability, integrity, and courage.

🎯 Requirements

• 12+ years of progressive leadership experience in pharmacy network management, pharmacy contracting, or PBM operations. • Experience across lines of business: Commercial, Medicare, Medicaid, Exchange • Deep understanding of the PBM ecosystem, pharmacy reimbursement models (AWP, MAC, NADAC), and the operational differences between traditional and pass-through/transparent PBMs. • Proven track record of successfully negotiating complex, multi-million dollar contracts with major national pharmacy chains and PSAOs. • Demonstrated experience building, leading, and mentoring cross-functional and remote teams in a high-growth environment. • Strong financial and analytical skills with the ability to understand complex pricing models and translate data into actionable network strategies. • Bachelor’s degree in Business, Healthcare Administration, Finance, or a related field; PharmD or Master’s degree (MBA/MHA) is highly preferred.

🏖️ Benefits

• Highly competitive wellness benefits including Medical, Pharmacy, Dental, Vision, and Life Insurance and AD&D Insurance • Flexible Spending Benefits • 401(k) Retirement Savings Program • Short-term and long-term disability • Discretionary Paid Time Off • Paid Company Holidays • Wellness Benefits • Commuter Benefits • Paid Parental Leave benefits • Employee Assistance Program (EAP) • Well-stocked kitchen in office locations • Professional development and training opportunities