VP, Pharmacy Operations POST NUMBER: 63231
Reports to: Chief Executive Officer
Employment Type: Full-time
Work Arrangement: Fully remote in USA only
Compensation: $200,000–$240,000
About the Role
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.
EEO Notice
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Representation Notice
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For residents of Ontario, Canada: Based on Highspring’s discussions with its Client, Highspring’s understanding is that this position for employment is a current vacancy (either through Highspring as a contractor or with the client directly).
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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;
- 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.