Remote VP, PBM & Medicare Part D Operations

Vaco; Town of Crown Point (NY); 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 build and lead an in-house PBM. Reporting to the CEO, the role will transition from outsourced to internal PBM operations and establish the needed processes, infrastructure, and team for long-term success.

The initial focus includes Part D responsibilities for the Medicare Advantage plan and aims to bring operations fully in-house for 2027.

Qualifications

• At least 5 years of Medicare Part D experience.
• Five+ years of leadership experience with a track record in pricing negotiations.
• Bachelor's degree in business, healthcare administration, pharmacy, or a related field.

Responsibilities

• Develop and execute the PBM strategy and roadmap for SevaRx and transition from external vendors.
• Establish internal infrastructure, processes, and procedures for PBM operations.
• 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 issue resolution, compliance, reporting, and transition to in-house operations.
• Coordinate preparation of PBM bid files to CMS with Product Manager.
• Ensure CMS, federal/state regulations and pharmacy laws compliance, including controls and audits.
• Develop pricing, rebates, and contracting strategies to optimize spend while maintaining access to care.
• Lead pricing negotiations and manage relationships with manufacturers and networks.
• Recruit and lead a high-performing PBM team with clear processes and accountability.
• Collaborate with clinical, operational, financial, and regulatory teams.

Skills

Medicare Part D

Leadership

PBM pricing

Strategic planning

Vendor management

Regulatory compliance

Healthcare operations

Education

Bachelor's degree

Job description

Vaco by Highspring is seeking a strategic Vice President of Pharmacy Benefit Management (PBM) to build and lead an in-house PBM. Reporting to the CEO, the role will transition from outsourced to internal PBM operations and establish the needed processes, infrastructure, and team for long-term success.

The initial focus includes Part D responsibilities for the Medicare Advantage plan and aims to bring operations fully in-house for 2027.