Vice President, Network & PBM Strategy

Vice President, Network & PBM Strategy

The Vice President, Network & PBM Strategy is a senior leader responsible for defining and executing enterprise network, payer, contracting, underwriting, and operational strategies across the PBM business. This role establishes vision, sets priorities, designs scalable governance and processes, and allocates resources to achieve financial, operational, and growth objectives aligned with the parent organization's long term strategy.

Partnering closely with the sales and account management, trade relations as well as executive leadership, this position drives enterprise level planning, payer and network strategy, portfolio performance, and market differentiation. The role has direct oversight of large chain pharmacy network contracting, PBM Underwriting and will influence and drive successful client pricing strategy, with accountability for PBM P&L performance, operational excellence, and brand growth across all payer segments.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

Financial & P&L Leadership

• Own departmental Profit & Loss (P&L), including revenue, cost of goods sold (COGS), administrative expense management, and margin optimization.
• Develop, manage, and forecast budgets; identify and execute strategies that drive sustainable profitability and scalable growth.
• Oversee advanced financial modeling, scenario analysis, and forecasting to support executive decision-making on client deals.
• Ensure pricing, contracting, and underwriting strategies align with financial targets, risk tolerance, and long-term client value.

Enterprise Network & Payer Strategy

• Establish and lead the payer and network contracting vision, strategy, and governance framework across all payer segments, including commercial, Medicare, Medicaid, and specialty markets.
• Oversee all network-related functions, including Pharmacy Network Contracting, Provider Contracting, Account Management, and Provider Data Management.
• Design and execute pharmacy and provider network strategies that optimize cost, access, quality, and performance.

Contracting, Negotiation & Partnerships

• Provide executive leadership for high-stakes national and regional payer, PBM, and network negotiations, including complex commercial, Medicare, Medicaid, and specialty agreements.
• Lead the negotiation and execution of contracts with major retail, mail-order, specialty pharmacy networks, and payer partners to ensure competitive pricing, access, and compliance.
• Champion innovative contracting approaches, including value-based, outcomes-based, and alternative reimbursement models.
• Build, maintain, and expand executive-level relationships with senior payer, PBM, and network leadership to advance long-term strategic partnerships.

PBM Underwriting & Pricing

• Direct PBM underwriting strategy, pricing governance, and financial risk assessment activities.
• Ensure underwriting models accurately reflect utilization patterns, rebate economics, network costs, reimbursement methodologies, and administrative expenses.
• Balance profitability, competitiveness, transparency, and client savings objectives across new business and renewals.

Strategic Planning & Market Leadership

• Partner with peer leaders to lead strategic planning, market analysis, business mapping, budgeting, and goal setting.
• Anticipate and respond to regulatory, legislative, and reimbursement trends that materially impact payer economics, access strategies, and compliance obligations.
• Identify emerging market opportunities, competitive threats, and evolving payer dynamics within the PBM and broader healthcare ecosystem.
• Shape, expand, and commercialize payer-focused service offerings that differentiate the organization and drive revenue growth.

Operational Leadership & Innovation

• Provide executive oversight of day-to-day operations across all assigned departments, ensuring consistency, efficiency, and scalability.
• Establish performance management, analytics, and reporting standards to ensure payer and network contract compliance, optimization, and transparency.
• Champion innovation through process improvement, analytics enhancement, automation, and the development of proprietary tools and capabilities.

Compliance, Governance & Risk Management

• Ensure compliance with all applicable federal, state, and industry laws, regulations, and contractual requirements.
• Partner with executive leaders across Legal, Finance, Clinical, Operations, and Consulting to ensure alignment, governance discipline, risk mitigation, and contract integrity.

Executive Advisory & Client Engagement

• Serve as an executive advisor to clients and internal leaders on payer strategy, network design, reimbursement optimization, and market dynamics.
• Support strategic client engagements, executive presentations, and complex payer discussions.
• Represent the organization as a senior thought leader with clients, partners, and industry stakeholders.

Supervisory Responsibilities

Manages assigned staff in the segment area. Responsible for the overall direction, coordination, and evaluation of the unit. Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems. Supports and enforces all company policies and procedures in a fair and consistent manner, taking corrective action whenever necessary.

Client Responsibilities

This is an internal and external client facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written). One must be able to; manage difficult or emotional client situations; Respond promptly to client needs; Solicit client feedback to improve service; Respond to requests for service and assistance from clients; Meet commitments to clients.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience

BA/BS Degree or equivalent; plus 15 years' related experience; 15 years of SME in respective area(s); and 12 years supervisory experience; Supervisory experience may be substituted with 12 years of MedImpact experience plus an appropriate external leadership training program and internal mentorship with a seasoned leader at the Vice President level or above that must be completed within 12 months in new position.

Computer Skills

• Advanced skill set in MS Office, Teams, Word, Excel, PowerPoint, Project, and Outlook

Other Skills and Abilities

• Recognized Subject Matter Expert in Pharmacy Network and Payer Contracting within the PBM industry.
• Deep expertise in MAC pricing, reimbursement models, payer economics, and network strategy.
• Proven success with full P&L accountability, including revenue, COGS, and operating expense control.
• Advanced knowledge of PBM underwriting methodologies and financial modeling.
• Strong executive presence, negotiation skills, and ability to lead complex multi stakeholder initiatives.
• Proficiency in Microsoft Office Suite and data driven decision making tools.

Reasoning Ability

• Ability to define problems, collect data, establish facts, and draw valid conclusions.

Mathematical Skills

• Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.

Language Skills

• Ability to make effective and persuasive speeches and presentations on controversial or complex topics to top management, public groups, and/or boards of directors.

Competencies To perform the job successfully, an individual should demonstrate the following competencies:

• Business Acumen
• Directing Others
• Organizational Agility
• Conflict Management
• Drive for Results
• Political Savvy
• Customer Focus
• Innovation Management
• Strategic Agility
• Decision Quality
• Managerial Courage

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is regularly required to sit and talk or hear. The employee is regularly required to stand; walk; use hands to finger, handle, or feel and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds.

Work Environment

The work environment characteristics described here are representative of