VP, Pharmacy Operations (PBM)

Work Arrangement: Fully remote in USA only Compensation: $200,000-$240,000 About the Role Reports to: Chief Executive Officer Work Arrangement: Fully remote in USA only Compensation: $200,000-$240,000 We are seeking a strategic Vice President of Pharmacy Benefit Management (PBM) to build and lead our in‑house PBM. Reporting directly to the CEO, this leader will oversee the transition from outsourced PBM services to an internally managed model, establishing the processes, infrastructure, and team needed for long‑term success. Initially, the role will oversee delegated Medicare Part D responsibilities for the Medicare Advantage plan, including escalated issues, compliance, and reporting. The goal is to bring Part D operations fully in‑house for the 2027 plan year. This is an opportunity to build a function from the ground up while improving member experience, strengthening compliance, and optimizing pharmacy costs. Key Responsibilities Develop and execute the strategy and roadmap for launching SevaRx and transitioning away from external vendors. Establish the internal infrastructure, processes, and procedures needed to support PBM operations. Oversee core PBM functions, including claims adjudication, pharmacy network contracting, formulary management, drug utilization review (DUR), prior authorization, specialty pharmacy, and Pharmacy and Therapeutics (P&T) Committee coordination. Oversee delegated Medicare Part D responsibilities, including issue resolution, compliance, reporting, and the transition to in‑house operations. Coordinate the preparation and timely submission of required PBM bid files to CMS in partnership with the Product Manager. Ensure compliance with applicable federal and state regulations, CMS requirements, and pharmacy laws, including internal controls, reporting, and audit readiness. Develop pricing, rebate, and contracting strategies to optimize pharmacy spend while maintaining quality and access to care. Lead pharmacy pricing negotiations and manage relationships with manufacturers, pharmacy networks, and other partners. Recruit and lead a high‑performing PBM team, establishing clear processes and accountability. Collaborate with internal stakeholders across clinical, operational, financial, and regulatory functions. Implement technology, best practices, and clinical programs that improve member experience and reduce pharmacy costs. Lead additional strategic initiatives and special projects as assigned. Required Qualifications At least 5 years of Medicare Part D experience. At least five years of leadership‑level experience, with a demonstrated track record in pharmacy pricing negotiations. Bachelor's degree in business, healthcare administration, pharmacy, or a related field. Strong knowledge of PBM business models, rebates, formulary management, pharmacy pricing, and cost optimization. Knowledge of healthcare regulatory compliance, CMS requirements, and pharmacy law. Financial acumen, including pricing strategy, financial performance, and P&L management. Experience with pharmacy operations, systems, technology, and vendor management. Ability to build processes, lead organizational change, and develop operational capabilities. Preferred Qualifications Pharmacist background or professional pharmacy experience. MBA or another advanced degree. Ideal Candidate Profile The ideal candidate is a strategic, process‑driven leader with deep Medicare Part D and PBM expertise. They are comfortable building a function from the ground up, establishing scalable processes, and driving operational improvements. This individual balances strategic vision with practical execution, works effectively within a decentralized organization, and collaborates across teams while leading with a lean direct‑report structure. Team Structure Reports directly to the CEO and initially supervises one direct report, a pharmacist responsible for Part D. Clinical responsibilities are distributed across other internal teams, requiring strong cross‑functional collaboration. Equal Opportunity Notice Highspring LLC (d/b/a Vaco by Highspring) and its parents, affiliates, and subsidiaries ("we," "our," or "Vaco by Highspring") are committed to the full inclusion of all qualified individuals and does not discriminate against any employee or applicant for employment because of race (including but not limited to traits historically associated with race such as hair texture and hair style), color, sex (includes pregnancy or related conditions), religion or creed, national origin, citizenship, age, disability, status as a veteran, union membership, ethnicity, gender, gender identity, gender expression, sexual orientation, marital status, political affiliation, or any other protected characteristics as required by applicable law. The company is also committed to ensuring that persons who need them are provided with reasonable accommodations; if an accommodation is needed to participate in the job application or interview process, please contact View email address on click.appcast.io. Vaco by Highspring also wants all applicants to know their rights that workplace discrimination is illegal. For residents of Ontario, Canada only: to the extent the position for employment is not with Highspring or not otherwise noted as vacant above, candidate should be informed that this role is to replace a presently employed person at Vaco by Highspring's client. Privacy Notice Vaco by Highspring respects your privacy and are committed to providing transparent notice of our policies. California residents may access Vaco by Highspring HR Notice at Collection for California Applicants and Employees here. Virginia residents may access our state specific policies here. Residents of all other states may access our policies here. Canadian residents may access our policies in English here and in French here. Residents of countries governed by GDPR and UK GDPR may access our policies here. Additionally, submissions to this position are subject to the use of AI to perform preliminary candidate screenings, focused on ensuring minimum job requirements noted in the position are satisfied. More details about Vaco by Highspring's use of AI can be found here ( Further assessment of candidates beyond this initial phase will be conducted by recruiters and hiring managers. Vaco by Highspring does not know and cannot opine on if its client's use of AI products in hiring. Pay Transparency Notice Determining compensation for this role (and others) at Vaco by Highspring depends upon a wide array of factors including but not limited to: the individual's skill sets, experience and training; licensure and certification requirements; office location and other geographic considerations; and other business and organizational needs. With that said, as required by local law, Vaco by Highspring believes that the following salary range referenced above reasonably estimates the base compensation for an individual hired into this position in geographies that require salary range disclosure. The individual may also be eligible for discretionary bonuses and/or participation in medical, dental, and vision benefits as well as the company's retirement plan (or similar retirement benefits). #J-18808-Ljbffr Vaco by Highspring