Vice President Pharmacy - 544328

Vice President of Pharmacy

Location: Remote (Candidates must reside in the Northeast U.S. and be open to an occasional onsite visit if needed)

Schedule: Full-time | Monday – Friday, 9:00 AM – 5:00 PM EST

Position Overview

We are seeking an accomplished, visionary executive to serve as our Vice President of Pharmacy . In this key leadership role, you will define and execute the organization's overarching pharmacy strategy, drive operational excellence, and optimize vendor performance across all lines of business. You will maintain executive oversight over clinical quality, financial stewardship, and regulatory compliance while partnering across C-suite and senior leadership teams to deliver high-impact, cost-effective pharmacy programs.

Note: This position is 100% remote, but candidates must be permanently located within the Northeast region.

Key Responsibilities

Pharmacy Strategy & Operations

• Provide strategic direction and executive oversight for all pharmacy benefit programs and day-to-day operational execution.
• Direct benefit administration, claims processing, formulary design and execution, utilization management (UM), and pharmacy network operations.
• Align enterprise pharmacy goals with broader corporate strategy, clinical standards, and growth objectives.

Vendor & Partner Governance

• Spearhead relationships, contract negotiations, and governance with pharmacy benefit managers (PBMs), specialty pharmacies, and strategic healthcare partners.
• Establish enterprise performance standards, hold partners accountable to rigorous Service Level Agreements (SLAs), and drive resolution on operational risks.
• Oversee major vendor transitions, procurement lifecycles, operational audits, and joint performance improvement initiatives.

Financial & Clinical Performance

• Lead pharmacy financial planning, including multi-year forecasting, budgeting, trend analytics, and total cost of care management.
• Direct strategies surrounding drug trend mitigation, specialty pharmacy pipelines, biosimilar adoption, and rebate optimization.
• Sponsor and scale innovative clinical initiatives targeted at medication access, adherence, safety, and health equity.

Regulatory & Compliance

• Ensure strict adherence of all pharmacy programs to state and federal statutes, CMS guidelines, and accreditation standards.
• Oversee delegated vendor compliance frameworks, audit readiness protocols, coverage determinations, and regulatory filings.
• Direct proactive operational risk assessments and mandate comprehensive corrective action plans (CAPs) when necessary.

Executive & Organizational Leadership

• Build, mentor, and inspire a high-performing pharmacy leadership team, fostering accountability, strategic capability, and leadership succession.
• Partner closely with executive peers across Finance, Actuarial, Clinical Operations, Product, Legal, IT, and Member Operations.
• Serve as the principal pharmacy voice to the Board of Directors, executive committees, and external industry stakeholders.

Qualifications & Requirements

Required Qualifications

• Location: Must currently reside within the Northeast United States (e.g., NY, NJ, PA, CT, MA, RI, VT, NH, ME).
• Experience: Proven executive leadership experience heading pharmacy operations within a health plan, managed care organization (MCO), or major PBM .
• PBM Oversight: Comprehensive mastery of PBM operations, claims adjudication architecture, formulary management, and utilization control mechanisms.
• Vendor & Contract Leadership: Extensive background in high-stakes PBM contract governance, SLA enforcement, and strategic partner negotiations.
• Fiscal Stewardship: Demonstrated expertise in pharmacy trend analysis, budget governance, risk-bearing models, and rebate economics.
• Executive Presence: Exceptional communication and presentation skills, with proven success aligning diverse matrixed stakeholders and leading remote organizations.

Preferred Qualifications

• Deep experience across employer-sponsored, self-funded (ASO), and commercial segments, as well as government programs.
• Extensive track record with high-cost specialty medications , cell and gene therapy strategies, and complex clinical programs.
• Demonstrated success leading enterprise-scale PBM implementations, contract conversions, or operational turnarounds.
• Prior executive-level tenure in a complex, multi-line healthcare system or integrated delivery network.

Work Schedule & Environment

• Work Arrangement: 100% Remote (Northeast residency required)
• Schedule: Monday through Friday, 9:00 AM – 5:00 PM EST