Vice President, PBM Management

Clover Health
United States
Workplace: RemoteFull timeUSD 278,000 - 320,000 annuallyFunction: Executive & General ManagementSkills: ["Executive leadership","Contract negotiation","Strategic thinking","Cross-functional collaboration","Organizational leadership"]

Own pharmacy strategy for Clover’s Medicare Advantage plan, including PBM partnership and contractual obligations, formulary strategy, pharmacy economics, and overall PBM financial performance. Lead governance and performance management, ensure PBM contractual compliance (including CMS requirements), and optimize macro pharmacy spend. Partner with Finance, Clinical Care Services, Network, Legal, and Product to improve quality, affordability, and plan outcomes while delivering executive recommendations on market and regulatory opportunities.

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Clover Health
Clover Health
1 day ago

Vice President, PBM Management

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Last checked: 12 hours agoStatus: Live

Job Summary

Own pharmacy strategy for Clover’s Medicare Advantage plan, including PBM partnership and contractual obligations, formulary strategy, pharmacy economics, and overall PBM financial performance. Lead governance and performance management, ensure PBM contractual compliance (including CMS requirements), and optimize macro pharmacy spend. Partner with Finance, Clinical Care Services, Network, Legal, and Product to improve quality, affordability, and plan outcomes while delivering executive recommendations on market and regulatory opportunities.
Location: United States
Workplace: Remote
Employment Type: Full time
Job Function: Executive & General Management
Seniority: Sr. Director level

Key Responsibilities

  • •Own Medicare Advantage pharmacy strategy across the health plan.
  • •Lead Clover’s PBM relationship, driving contract performance, service levels, cost management, and adherence to contractual obligations.
  • •Develop formulary strategy balancing clinical quality, member experience, and financial performance.
  • •Ensure PBM contractual compliance and oversight across vendor agreements and CMS requirements.
  • •Lead PBM governance improvements, rebate/pharmacy economics partnership with Finance, and executive recommendations on regulations, market dynamics, and strategic opportunities.

Pay and Benefits

Salary: USD 278,000 - 320,000 annually
Equity and Bonus:Equity
Perks:Health InsuranceDentalVision401kAnnual BonusEquityRemote WorkPaid Leave

Key Requirements

  • •Led pharmacy strategy within a Medicare Advantage plan or similarly complex payer.
  • •Deep experience managing PBMs and pharmacy vendors, including formulary and contract enforcement.
  • •Understands formulary management, PBM contractual obligations, 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, including experience building organizations across matrixed teams.
Experience:Medicare AdvantagePharmacyPBMHealthcare payerFormulary managementVendor management
Skills:Executive leadershipContract negotiationStrategic thinkingCross-functional collaborationOrganizational leadership
Languages:English
Tech Stack:Clover Assistant

Company Brief

Clover Health
Clover Health is a technology-driven health insurance company offering Medicare Advantage plans that combine clinical care coordination, data analytics, and value-based care to improve outcomes and reduce costs for seniors.
Industry: Health Insurance (Payers)
Company Size: Enterprise (1,001+ employees)
Growth: Public Company
Valuation: Public Company (Market Cap in USD)
Funding: IPO / Publicly Listed
Headquarters: Jersey City, United States
Founded: 2014
WebsiteLinkedIn