Vice President – PBM Management

Clover Health

. Own the Medicare Advantage pharmacy strategy across the health plan .

Posted 9/16/2026full-timeRemote • United StatesLead💰 $278,000 - $320,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Medicare Advantage pharmacy strategy, including formulary management, PBM contract enforcement, and compliance with CMS regulations. Proven ability to lead teams, influence executives, and drive financial performance through strategic partnerships and vendor management.

Highest-signal resume keywords

Medicare Advantage Pharmacy StrategyPBM ManagementFormulary ManagementContract NegotiationPharmacy Economics

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Pharmacy Strategy DevelopmentContractual ComplianceCost ManagementForecastingRebate Strategy

Soft Skills

Influencing ExecutivesTeam LeadershipCross-Functional Collaboration

Industry Keywords

PBMCMS RegulationsPharmacy Spend ManagementPart D Stars InitiativesVendor Relationships

About the role

Key responsibilities & impact

Own the Medicare Advantage pharmacy strategy across the health plan
Lead Clover's relationship with its PBM, including contract performance, service levels, cost management, and contractual adherence
Develop formulary strategy balancing clinical quality, member experience, and financial performance
Ensure PBM contractual compliance and oversight across vendor agreements and CMS requirements
Identify macro pharmacy spend management opportunities
Build and lead a team of pharmacy associates managing critical PBM and vendor relationships
Partner with Finance on forecasting, rebate strategy, and pharmacy economics
Partner with Clinical Care Services, Network, Legal, and Product leaders to maximize PBM performance and financial outcomes
Support enterprise Part D Stars initiatives through PBM execution, contractual fulfillment, and formulary decisions
Provide executive recommendations on emerging pharmacy regulations, market dynamics, and strategic opportunities
Identify opportunities to improve quality, affordability, and financial performance across PBM contracts
Build executive and PBM partner relationships, assess performance and compliance, and develop a multi-year pharmacy strategy
Implement improvements in PBM governance and performance management
Establish operating rhythms across pharmacy strategy, finance, legal, and care management teams

Requirements

What you’ll need

Experience leading pharmacy strategy inside a Medicare Advantage plan or similarly complex payer
Deep experience managing PBMs and pharmacy vendors
Understanding of formulary management, PBM contract enforcement, 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
Experience building organizations and leading through influence across highly matrixed teams

Benefits

Comp & perks

Competitive base salary
Equity opportunities
Performance-based bonus program
401(k) matching
Regular compensation reviews
Comprehensive medical, dental, and vision coverage
No-Meeting Fridays
Monthly company holidays
Mental health resources
Generous flexible time-off policy
Remote-first culture
Learning programs
Mentorship
Professional development funding
Regular performance feedback and reviews
Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities
Reimbursement for office setup expenses
Monthly cell phone & internet stipend
Collaboration with global teams
Paid parental leave for all new parents