Pbm Consulting Jobs in California (NOW HIRING)

United States of America (Exempt) $208,071 - $301,704 - $395,336. "Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors. A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate." This position is not eligible for Sponsorship.

The Vice President, Network & PBM Strategy is a senior leader responsible for defining and executing enterprise network, payer, contracting, underwriting, and operational strategies across the PBM business. This role establishes vision, sets priorities, designs scalable governance and processes, and allocates resources to achieve financial, operational, and growth objectives aligned with the parent organization’s long‑term strategy. Partnering closely with sales and account management, trade relations, and executive leadership, this position drives enterprise‑level planning, payer and network strategy, portfolio performance, and market differentiation. The role has direct oversight of large chain pharmacy network contracting, PBM underwriting and will influence and drive successful client pricing strategy, with accountability for PBM P&L performance, operational excellence, and brand growth across all payer segments.

• Financial & P&L Leadership: Own departmental Profit & Loss (P&L), including revenue, cost of goods sold (COGS), administrative expense management, and margin optimization; develop, manage, and forecast budgets; identify and execute strategies that drive sustainable profitability and scalable growth; oversee advanced financial modeling, scenario analysis, and forecasting to support executive decision‑making on client deals; ensure pricing, contracting, and underwriting strategies align with financial targets, risk tolerance, and long‑term client value.
• Enterprise Network & Payer Strategy: Establish and lead the payer and network contracting vision, strategy, and governance framework across all payer segments (commercial, Medicare, Medicaid, specialty); oversee all network‑related functions, including Pharmacy Network Contracting, Provider Contracting, Account Management, and Provider Data Management; design and execute pharmacy and provider network strategies that optimize cost, access, quality, and performance.
• Contracting, Negotiation & Partnerships: Provide executive leadership for high‑stakes national and regional payer, PBM, and network negotiations; lead the negotiation and execution of contracts with major retail, mail‑order, specialty pharmacy networks, and payer partners; champion innovative contracting approaches, including value‑based, outcomes‑based, and alternative reimbursement models; build, maintain, and expand executive‑level relationships with senior payer, PBM, and network leadership.
• PBM Underwriting & Pricing: Direct PBM underwriting strategy, pricing governance, and financial risk assessment activities; ensure underwriting models accurately reflect utilization patterns, rebate economics, network costs, reimbursement methodologies, and administrative expenses; balance profitability, competitiveness, transparency, and client savings objectives across new business and renewals.
• Strategic Planning & Market Leadership: Partner with peer leaders to lead strategic planning, market analysis, business mapping, budgeting, and goal setting; anticipate and respond to regulatory, legislative, and reimbursement trends; identify emerging market opportunities, competitive threats, and evolving payer dynamics; shape, expand, and commercialize payer‑focused service offerings.
• Operational Leadership & Innovation: Provide executive oversight of day‑to‑day operations across all assigned departments; establish performance management, analytics, and reporting standards; champion innovation through process improvement, analytics enhancement, automation, and the development of proprietary tools and capabilities.
• Compliance, Governance & Risk Management: Ensure compliance with all applicable federal, state, and industry laws, regulations, and contractual requirements; partner with executive leaders across Legal, Finance, Clinical, Operations, and Consulting to ensure alignment, governance discipline, risk mitigation, and contract integrity.
• Executive Advisory & Client Engagement: Serve as an executive advisor to clients and internal leaders; support strategic client engagements, executive presentations, and complex payer discussions; represent the organization as a senior thought leader.
• Supervisory Responsibilities: Manage assigned staff; coordinate and evaluate unit operations; conduct hiring, training, performance appraisal, rewarding, disciplining, and problem resolution.
• Client Responsibilities: Serve internal and external clients with excellent customer service and interpersonal communication skills; manage difficult or emotional client situations; respond promptly to client needs; solicit feedback to improve service; meet commitments to clients.

• BA/BS Degree or equivalent; plus 15 years of related experience; 15 years of SME in the relevant area; and 12 years supervisory experience (substitute eligible if internal MedImpact experience plus approved leadership training).
• Advanced skill set in MS Office, Teams, Word, Excel, PowerPoint, Project, and Outlook.
• Recognized subject matter expert in Pharmacy Network and Payer Contracting within the PBM industry.
• Deep expertise in MAC pricing, reimbursement models, payer economics, and network strategy.
• Proven success with full P&L accountability, including revenue, COGS, and operating expense control.
• Advanced knowledge of PBM underwriting methodologies and financial modeling.
• Strong executive presence, negotiation skills, and ability to lead complex multi‑stakeholder initiatives.
• Proficiency in Microsoft Office Suite and data‑driven decision‑making tools.
• Ability to define problems, collect data, establish facts, and draw valid conclusions.
• Mathematical skills: application of fractions, percentages, ratios, and proportions to practical situations.
• Language skills: ability to make effective and persuasive speeches and presentations on complex topics to top management, public groups, and/or boards of directors.

• Business Acumen
• Directing Others
• Organizational Agility
• Conflict Management
• Drive for Results
• Political Savvy
• Customer Focus
• Innovation Management
• Strategic Agility
• Decision Quality
• Managerial Courage

The employee is regularly required to sit, talk, or hear; stand; walk; use hands to finger, handle, or feel; and reach with hands and arms. Occasionally lift and/or move up to 25 pounds. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

The work environment can include exposure to moving mechanical parts, high or precarious places, fumes or airborne particles, toxic or caustic chemicals, outdoor weather conditions, risk of electrical shock or vibration. Noise level is usually moderate. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

This position works on‑site at the San Diego Headquarters or other company location (or from a remote location with management approval based on business requirements). Must provide adequate support to internal clients and be available for regular interactions and coordination of work with other employees, colleagues, clients, or vendors.

Exempt level position requiring the incumbent to work the hours needed to fully accomplish job responsibilities and meet deadlines. Flexibility to work beyond traditional hours, including nights, weekends, or holidays is required. Core business hours are Monday through Friday, 8:00am to 5:00pm.

Position requires both domestic and international travel of up to 25% of the time. A valid passport and ability to leave the United States is required.

• Medical / Dental / Vision / Wellness Programs
• Paid Time Off / Company Paid Holidays
• Incentive Compensation
• 401(k) with Company match
• Life and Disability Insurance
• Tuition Reimbursement
• Employee Referral Bonus

Male/Female/Disabilities/Veterans. OSHA/ADA: To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily; reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.