[Hiring] Pharmacy Strategy and Market Intelligence Lead @Quantum Health

Role Description

This role leads our commercial pharmacy strategy from research to executive decisions in 90 days. It combines two areas of focus: building the necessary decision insights and understanding what carriers, PBMs, navigation companies, and health systems are doing and what actually works.

The Lead will turn landscape research, competitor intelligence, and our claims data into frameworks and options the executive team can decide on. The outcome by day 90 are executive team decisions that move pharmacy total cost of care (TCOC) in 2027 and place strong bets for 2028 with alignment on likely savings target and investment.

This role requires a lead who understands the pharmacy market, has deep knowledge of the competitive landscape, and is able to size the options with our data to drive the executive team to decisions.

Our pharmacy strategy will need to drive the following decisions based on ability to impact TCOC in the time frames required for our book of business:

• 0–12 months impact:
  • Optimization of existing solutions
  • Net new solutions
  • Biosimilar-first formulary, infusion site of care, specialty high-cost drug clinical criteria and lifestyle support, adherence outreach
• 12–24 months impact:
  • Optimization of existing solutions and partners
  • Net new solutions
  • Transparent pass-through PBM terms; integrated medical and pharmacy specialty management
• 24–36 months impact:
  • Optimization of existing solutions and partners
  • Net new solutions
  • Gene therapy and oncology drug financing, pipeline watch list

Responsibilities

• Run the pharmacy strategy work end to end: plan, cadence, team tasks, and a decision log.
• Build the frameworks that turn research into choices: a pharmacy cost driver tree (price, use, and mix by channel), an evidence grid for each intervention, and an options scorecard (value, time to impact, feasibility, risk).
• Size each option with the data analyst and finance partner: eligible members × engagement × effect − cost, linked to the TCOC goal and to performance guarantee exposure.
• Map what carriers and their PBMs (Optum Rx, CVS Caremark, Express Scripts, CarelonRx), transparent PBMs, navigation companies, and health systems offer, how well it works, and how it is priced.
• Identify and map solutions including disruptors, early stage solutions, and established mechanisms to drive TCOC.
• Track the pipeline and policy that will shape 2028 and beyond: biosimilar launches, high cost specialty drugs, cell and gene therapies, PBM reform, and drug pricing policy.
• Run multiple expert calls a week through an expert network, and gather what clients and benefits consultants are asking for.
• Establish a competitor heat map and market brief for leadership.
• Help the executive leadership team learn the pharmacy world quickly, working with the pharmacy economics lead to develop fact base and address questions and concerns.
• Coordinate the internal team of clinical pharmacist, data analyst, finance partner, and client lead without managing them directly.
• Use AI research tools to speed up landscape scans, evidence tables, and draft materials, and check what they produce for accuracy.

What success looks like

• By Day 30: Fact base reviewed; pharmacy spend at BOB and client split into price, use, and mix; current programs and their results; PBM contract terms reviewed where available.
• By Day 60: Evidence grid and competitor heat map complete; expert calls done; external solution landscape complete; options shortlisted.
• By Day 90: Executive team makes key decisions to inform 2027 and 2028 roadmap tied to specific TCOC reductions, growth, and retention goals.

Qualifications

• 8+ years in healthcare strategy, with at least 3 in pharmacy benefits, PBM, payer, or benefits consulting.
• Strategy consulting or internal strategy experience leading work from research to executive decisions under tight deadlines.
• Working knowledge of PBM economics: rebates, spread versus pass-through pricing, specialty pharmacy, and medical versus pharmacy benefit drugs.
• Track record in market and competitive intelligence: primary research, expert interviews, competitor profiles, and synthesis.
• Comfort with claims data and financial models; able to build or direct a sizing model with finance.
• Clear, concise writing and presentations for C-suite audiences.

Preferred

• Experience at a carrier, PBM, transparent PBM, navigation company, or benefits consultancy (Mercer, Aon, WTW).
• Network of pharmacy and benefits experts to draw on quickly.
• Knowledge of the specialty drug pipeline, biosimilars, GLP-1 policy, and gene therapy financing.
• Experience with self-funded employer clients and performance guarantees.
• MBA, MPH, PharmD, or similar advanced degree.

Who you work with and role details

• Reports to: Chief Medical Officer
• Works closely with: Pharmacy economics lead, clinical pharmacist, pharmacy data analyst, actuary, finance partner, client and consultant relations lead, legal
• Executive audience: CEO and executive team
• Location: Remote

We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.