Vice President, PBM Management

Clover Health

10d•$278,000 - $320,000•Remote

About The Position

Build the pharmacy strategy behind one of the country's most innovative Medicare Advantage plans. At Clover Health, we are committed to providing high-quality, affordable, and easy-to-understand healthcare plans for America's seniors. We prioritize preventive care while leveraging data and technology through the Clover Assistant, giving physicians a more complete picture of every member and helping deliver better outcomes at lower cost. Pharmacy is one of the most important levers in Medicare Advantage. It influences affordability, clinical outcomes, member experience, and long-term plan performance. We're looking for an executive to own that strategy. As Vice President of PBM Management, you'll lead the pharmacy strategy function for Clover's Medicare Advantage plan. You'll own our PBM partnership, PBM contractual obligations, formulary strategy, pharmacy economics, and overall PBM financial performance. You'll partner closely with executive leadership to ensure pharmacy and PBM management are a competitive advantage—not simply a cost center. Reporting directly to the CEO of the Medicare Advantage business, you'll help shape enterprise strategy while leading PBM strategy, contract enforcement, and financial optimization.

Requirements

Led pharmacy strategy inside a Medicare Advantage plan or similarly complex payer.
Deep experience managing PBMs and pharmacy vendors.
Understand formulary management, PBM contract enforcement, CMS regulations, and pharmacy economics.
Can balance clinical quality, member experience, and financial performance.
Equally comfortable influencing executives and driving contract negotiation and enforcement details.
Enjoy building organizations and leading through influence across highly matrixed teams.

Responsibilities

Own the Medicare Advantage pharmacy strategy across the health plan.
Lead Clover's relationship with its PBM, driving contract performance, service levels, cost management, and strict adherence to contractual obligations.
Develop formulary strategy balancing clinical quality, member experience, and financial performance.
Ensure PBM contractual compliance and oversight across all vendor agreements and CMS requirements.
Responsible for identification of macro pharmacy spend management
Build and lead a team of pharmacy associates to assist with 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 by ensuring PBM execution, contractual fulfillment, and formulary decisions enable program success while partnering closely with the dedicated Pharmacy Stars & Cares Initiatives team.
Provide executive recommendations on emerging pharmacy regulations, market dynamics, and strategic opportunities.
Continuously identify opportunities to improve quality, affordability, and overall financial performance across PBM contracts.