Vice President, PBM Management

5 hours, 55 minutes ago
Full-time
Executive
Operations
Clover Health

Clover Health

Clover Health is a data-focused health insurance company that is revolutionizing the Medicare Advantage space by integrating innovative technology into its plans. With a focus on optimizing medical outcomes and reducing costs, Clover Health uses analyt...

Insurance
251-1K
Founded 2014
$925M raised

Description

  • Own the Medicare Advantage pharmacy strategy across the health plan.
  • Lead the PBM relationship, including contract performance, service levels, cost management, and contractual obligations.
  • Develop formulary strategies that balance clinical quality, member experience, and financial performance.
  • Oversee PBM contractual compliance, vendor agreements, and CMS requirements.
  • Identify opportunities to manage and reduce pharmacy spending.
  • Build and lead a pharmacy team supporting PBM and vendor relationship management.
  • Partner with Finance on forecasting, rebate strategy, and pharmacy economics.
  • Collaborate with Clinical Care Services, Network, Legal, Product, and Pharmacy Stars teams.
  • Provide executive recommendations on pharmacy regulations, market dynamics, and strategic opportunities.
  • Improve PBM governance, affordability, quality, contract performance, and financial returns.

Requirements

  • Experience leading pharmacy strategy within a Medicare Advantage plan or similarly complex payer.
  • Deep experience managing PBMs and pharmacy vendors.
  • Expertise in formulary management, PBM contract enforcement, CMS regulations, and pharmacy economics.
  • Ability to balance clinical quality, member experience, and financial performance.
  • Experience influencing executives and managing contract negotiation and enforcement details.
  • Ability to build organizations and lead through influence across matrixed teams.

Benefits

  • Base salary range of $278,000–$320,000 USD.
  • Equity opportunities, performance-based bonus, 401(k) matching, and regular compensation reviews.
  • Comprehensive medical, dental, and vision coverage.
  • Flexible time off, monthly company holidays, mental health resources, and No-Meeting Fridays.
  • Remote-first work culture, office setup reimbursement, and monthly cell phone and internet stipend.
  • Professional development funding, learning programs, mentorship, and performance feedback.
  • Employee Stock Purchase Plan with discounted equity opportunities.
  • Paid parental leave for all new parents.

Interested in this position?

Apply directly on the company website

Apply Now

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