VP, Pharmacy Operations; PBM

Work Arrangement: Fully remote in USA only

Compensation: $200,000-$240,000

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.

• Develop and execute the strategy and roadmap for launching Seva Rx 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.

• 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.

• Pharmacist background or professional pharmacy experience.
• MBA or another advanced degree.

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…