[Hiring] Vice President, PBM Management @Clover Health

Role Description

Build the pharmacy strategy behind one of the country's most innovative Medicare Advantage plans. At Clover Health, we are committed to providing high-quality, affordable, and easy-to-understand healthcare plans for America's seniors. We prioritize preventive care while leveraging data and technology through the Clover Assistant, giving physicians a more complete picture of every member and helping deliver better outcomes at lower cost.

Pharmacy is one of the most important levers in Medicare Advantage. It influences affordability, clinical outcomes, member experience, and long-term plan performance. We're looking for an executive to own that strategy.

As Vice President of PBM Management, you'll lead the pharmacy strategy function for Clover's Medicare Advantage plan. You'll own our PBM partnership, PBM contractual obligations, formulary strategy, pharmacy economics, and overall PBM financial performance. You'll partner closely with executive leadership to ensure pharmacy and PBM management are a competitive advantage—not simply a cost center.

Reporting directly to the CEO of the Medicare Advantage business, you'll help shape enterprise strategy while leading PBM strategy, contract enforcement, and financial optimization.

As Vice President, PBM Management, you will:

• Own the Medicare Advantage pharmacy strategy across the health plan.
• Lead Clover's relationship with its PBM, driving contract performance, service levels, cost management, and strict adherence to contractual obligations.
• Develop formulary strategy balancing clinical quality, member experience, and financial performance.
• Ensure PBM contractual compliance and oversight across all vendor agreements and CMS requirements.
• Responsible for identification of macro pharmacy spend management.
• Build and lead a team of pharmacy associates to assist with managing critical PBM and vendor relationships.
• Partner with Finance on forecasting, rebate strategy, and pharmacy economics.
• Partner with Clinical Care Services, Network, Legal, and Product leaders to maximize PBM performance and financial outcomes.
• Support enterprise Part D Stars initiatives by ensuring PBM execution, contractual fulfillment, and formulary decisions enable program success while partnering closely with the dedicated Pharmacy Stars & Cares Initiatives team.
• Provide executive recommendations on emerging pharmacy regulations, market dynamics, and strategic opportunities.
• Continuously identify opportunities to improve quality, affordability, and overall financial performance across PBM contracts.

Success in this role looks like:

• First 90 days:
  • Build trusted relationships with executive leadership and key PBM partners.
  • Assess PBM performance, contract compliance, formulary strategy, and financial optimization opportunities.
  • Develop a multi-year pharmacy strategy aligned to Clover's Medicare Advantage objectives.
• First 6 months:
  • Implement measurable improvements in PBM governance and performance management.
  • Deliver strategic recommendations on formulary optimization and pharmacy economics.
  • Establish operating rhythms across internal pharmacy strategy, finance, legal, and care management teams.
• Long term:
  • Pharmacy becomes a strategic competitive advantage for Clover.
  • Improved pharmacy affordability while maintaining or improving quality.
  • Best-in-class PBM oversight, contract performance, and financial return.
  • High-performing pharmacy organization that scales with the business.

Qualifications

• You've led pharmacy strategy inside a Medicare Advantage plan or similarly complex payer.
• You have deep experience managing PBMs and pharmacy vendors.
• You understand formulary management, PBM contract enforcement, CMS regulations, and pharmacy economics.
• You can balance clinical quality, member experience, and financial performance.
• You're equally comfortable influencing executives and driving contract negotiation and enforcement details.
• You enjoy building organizations and leading through influence across highly matrixed teams.

Benefits

• Financial Well-Being: Competitive base salary and equity opportunities, performance-based bonus program, 401k matching, and regular compensation reviews.
• Physical Well-Being: Comprehensive medical, dental, and vision coverage.
• Mental Well-Being: Initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy.
• Professional Development: Learning programs, mentorship, professional development funding, and regular performance feedback and reviews.
• Additional Perks:
  • Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities.
  • Reimbursement for office setup expenses.
  • Monthly cell phone & internet stipend.
  • Remote-first culture, enabling collaboration with global teams.
  • Paid parental leave for all new parents.
  • And much more!