VP, Health Plan & PBM Relations

ExactCare Pharmacy; United States; Remote; USD 150,000 - 250,000; Full time

Job summary

A leading pharmacy management company seeks a VP, Health Plan & PBM Relations to manage partnerships with health plans and PBMs. The successful candidate will drive demand, negotiate contracts, and contribute to strategic planning within a dynamic and collaborative environment.

Benefits

Medical, dental, and vision coverage

Flexible spending account

401(k) plan

Paid Time Off

Company-paid life insurance

Short-term disability benefits

Qualifications

• 10+ years of progressive experience in relationship management and strategic partnerships.
• Health Plan/PBM contracting experience preferred.
• Strong understanding of healthcare dynamics.

Responsibilities

• Lead development of strategic partnerships with health plans and PBMs.
• Manage contracting and negotiations for reimbursement.
• Oversee annual planning, forecasting, and budgeting processes.

Skills

Leadership

Partnership Building

Communication

Strategic Thinking

Negotiation

Market Analysis

Education

Bachelor's degree in business/business administration, Healthcare, or related field

Advanced degree in Business/Business Administration, Healthcare, or related field

Job description

VP, Health Plan & PBM Relations page is loaded

VP, Health Plan & PBM Relations

Apply locations US - Remote time type Full time posted on Posted 7 Days Ago job requisition id R-106459

AnewHealth is one of the nation’s leading pharmacy care management companies that specializes in caring for people with the most complex, chronic needs—wherever they call home. We enable better outcomes for patients and the healthcare organizations who support them. Established in 2023 through the combination of ExactCare and Tabula Rasa HealthCare, we provide a suite of solutions that includes comprehensive pharmacy services; full-service pharmacy benefit management; and specialized support services for Program of All-Inclusive Care for the Elderly. With over 1,400 team members, we care for more than 100,000 people across all 50 states.

Job Details

The VP, Health Plans & PBM Relations will lead the development and management of strategic partnerships with health plans, PBMs, and other key external stakeholders to drive demand for AnewHealth services. This role will manage contracting and negotiations and provide strategic guidance on market trends, policy changes, and reimbursement strategies. The VP will work closely with internal teams to align business goals, market segment strategies, and growth initiatives, while ensuring service excellence and cross-functional collaboration. Additionally, this leader will contribute to the annual planning, forecasting, and budgeting processes and foster a high-performing, engaged team. This role requires intense cross-functional collaboration and leadership of industry, products, and people.

Responsibilities

• Solve patient experience barriers with health plans including co-pay differential and medication synchronization fulfillment timing / overrides

• Establish and manage payer performance expectations including STARS, outcomes, and value-based programs (e.g., quality bonus programs)

• Build relationships with key external partners in market access, including Health Plans, PBMs, to stimulate, surface, and shape demand for AnewHealth services, exploring new opportunities for value creation and ensuring service levels (e.g., QBRs).

• Identify new partners within the organization and partners with growth leaders to propose services.

• Stay on top of trends and information with health plans and PBMs that can impact the business, keeping leadership and key stakeholders informed of changes (e.g. policy, reimbursements)

• Interpret the impact of marketplace changes and advise leadership on how to react and position the business.

• Provide strategies and growth plans for market segments (e.g., Nationals, Blues, SNP Plans, Medicaid, etc.) that inform business goals, focus areas, closing strategies, capabilities, and activities.

• Own the contracting and negotiation with reimbursement partners including comprehensive contract lifecycle management.

• Actively contribute to the annual brand planning, forecasting, and budgeting process.

• Recruit, motivate, and retain a high-performing organization, ensuring cross-functional knowledge and mastery of communicating key concepts, driving employee engagement, satisfaction, and morale.

The above essential functions are representative of major duties of positions in this job classification. Specific duties and responsibilities may vary based upon departmental needs. Other duties may be assigned similar to the above consistent with knowledge, skills and abilities required for the job. Not all of the duties may be assigned to a position.

Qualifications

These represent the desired qualifications of the ideal candidate. They are not meant to limit consideration for candidates who do not meet all of the standards listed. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Required: Bachelor's degree in business/business administration, Healthcare, or related field or significant related experience.

• Preferred: Advanced degree in Business/Business Administration, Healthcare, or related field.

• Preferred: Health Plan/PBM Pharmacy Contracting experience.

• Required: 10+ years of progressive experience in relationship management and driving value from strategic partnerships.

• Strongly Preferred: Strong understanding/experience in healthcare, particularly with health plans, PBMs, or similar groups.

Skills & Abilities

• Required: Proven ability to build effective partnerships to drive increased value and expanded business opportunities.

• Required: Adept at creating productive, long-term customer relationships.

• Required: Excellent leadership and coaching, ability to lead teams and stay on top of market trends.

• Required: Excellent written and verbal communication skills, and professionalism when working with account stakeholders

• Required: Can model positive energy and handle stress in the face of challenges, deadlines, and financial pressures in a fast-paced, dynamic environment

• Required: Ability to successfully perform with key decision makers at the Executive/C-Suite level of mid-size and large companies.

• Required: Experience conducting presentations to groups

• Required: Detail oriented and able to prioritize workload

• Required: Strong computer skills including using Word processors, spreadsheets, and database software

• Preferred: Ability to manage multiple priorities and work independently

• Preferred: Demonstrated leadership skills

Physical & Mental Demands

• This position is administrative in nature and will present physical demands requisite to a position requiring: hearing, seeing, sitting, standing, talking, and walking. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Must be able to commute to multiple site locations within assigned territory. May be necessary to work extended hours as needed.

Schedule

• This is a full-time position with an expectation to work an average of 40 hours per week and be available outside of normal business hours to meet customer expectations on an ad-hoc basis. Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed. This may be considered a hybrid position based on manager discretion.

Travel

• Travel will be required for special department events, trade shows, conferences, and other client engagements.

AnewHealth offers a comprehensive benefit package for full-time employees that includesmedical/dental/vision, flexible spending, company-paid life insurance and short-term disability as well as voluntary benefits,401(k), Paid Time Off and paid holidays. Medical, dental and vision coverage are effective 1st of the month following date of hire .

AnewHealth provides equal employment opportunity to all qualified applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status, or other legally protected classification in the state in which a person is seeking employment. Applicants are encouraged to confidentially self-identify when applying. Local applicants are encouraged to apply. We maintain a drug-free work environment. Applicants must be eligible to work in this country.