Head of PBM & Medicare Part D Transformation

Vaco; Crown Point (IN); Remote; USD 200,000 - 240,000; Full time

Job summary

Vaco by Highspring is seeking a strategic Vice President of Pharmacy Benefit Management (PBM) to lead the transition from outsourced to in-house PBM, reporting to the CEO. This remote, USA-only role oversees Medicare Part D responsibilities and will build the internal PBM function for long-term cost optimization and compliance.

Ideal candidates bring Medicare Part D experience, strong leadership, and deep PBM knowledge to design pricing, provider networks, and clinical programs while

Qualifications

• Minimum 5 years of Medicare Part D experience.
• 5+ years of leadership experience with pricing negotiations.
• Bachelor's degree in business, healthcare administration, pharmacy, or related field.
• Strong knowledge of PBM models, rebates, formulary management, and cost optimization.
• Familiarity with CMS requirements and pharmacy law.
• Financial acumen and P&L management.
• Experience with pharmacy operations, systems, and vendor management.
• Ability to build processes and lead organizational change.

Responsibilities

• Develop strategy and roadmap for launching SevaRx and transition from external vendors.
• Establish internal PBM infrastructure, processes, and procedures.
• Oversee PBM functions: claims adjudication, network contracting, formulary management, DUR, prior authorization, specialty pharmacy, and P&T coordination.
• Oversee delegated Medicare Part D responsibilities including compliance and reporting.
• Coordinate PBM bid file submissions to CMS with Product Manager.
• Ensure compliance with federal/state regulations and audit readiness.
• Develop pricing, rebate, contracting strategies to optimize spend.
• Lead pricing negotiations with manufacturers and networks.
• Build and lead a high-performing PBM team.
• Collaborate with clinical, operational, financial, regulatory stakeholders.
• Implement technology and clinical programs to improve member experience and reduce costs.
• Lead additional strategic initiatives as assigned.

Skills

Medicare Part D experience

Leadership experience

PBM knowledge

Pricing negotiations

Regulatory compliance

Financial acumen

Vendor management

Cross-functional collaboration

Process building

Education

Bachelor's degree in business, healthcare administration, pharmacy, or related field

MBA or other advanced degree

Pharmacist background or professional pharmacy experience

Job description

Vaco by Highspring is seeking a strategic Vice President of Pharmacy Benefit Management (PBM) to lead the transition from outsourced to in-house PBM, reporting to the CEO. This remote, USA-only role oversees Medicare Part D responsibilities and will build the internal PBM function for long-term cost optimization and compliance.

Ideal candidates bring Medicare Part D experience, strong leadership, and deep PBM knowledge to design pricing, provider networks, and clinical programs while