Pharmacy Vendor Manager

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It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary

Reporting to the Manager of Pharmacy Contracting and Reporting, the Pharmacy Vendor Manager is a key strategic leader responsible for overseeing relationships and contracts with pharmacy benefit managers (PBMs) and specialty pharmacy vendors. This position ensures that vendor performance aligns with contractual and regulatory obligations but as well as with the organization's long-term strategic goals. The Pharmacy Vendor Manager will work closely with senior leadership to identify and leverage opportunities for innovation and improvement within the pharmacy benefits space, driving initiatives that enhance value and optimize outcomes across Medicaid, Medicare, and commercial markets.

Our Investment In You

• Full-time remote work
• Competitive salaries
• Excellent benefits
  
  

Key Functions/Responsibilities

• Lead and manage the organization's relationships with PBMs and other pharmacy vendors, ensuring alignment with the organization's broader strategic goals. Serve as a subject matter expert on PBM functions, market trends, and regulatory impacts.
• Develop and refine strategies for contract negotiations and performance management, with a focus on maximizing value through enhanced contract terms, cost savings, and innovative service delivery models. Ensure vendors meet service level agreements (SLAs) and performance metrics, with particular attention to regulatory requirements and market changes.
• Monitor vendor performance and compliance through strategic data analysis, anticipating potential issues and addressing them proactively. Oversee corrective action processes, ensuring vendor accountability for service delivery, compliance, and performance deficiencies.
• Generate high-level reports and insights for senior leadership on vendor performance, compliance, cost trends, and emerging pharmacy benefit challenges. Leverage data to inform decision-making and identify opportunities for program improvements and cost optimization.
• Act as a central liaison across multiple departments—Compliance, Finance, Legal, and Clinical teams—to ensure a coordinated approach to pharmacy benefits management. Foster collaborative relationships to drive initiatives that improve internal processes and member outcomes.
• Stay abreast of industry trends and regulatory changes, particularly around PBM practices and policies. Lead efforts to adjust strategies in response to market and legislative developments that affect the organization’s pharmacy benefits programs.
• Collaborate with internal teams and vendors to explore and implement innovative pharmacy solutions (e.g., value-based contracting, specialty pharmacy models) that drive quality care, cost-efficiency, and member satisfaction.
• Lead governance of vendor contracts and performance by organizing and leading regular executive-level meetings with vendors. Drive accountability for long-term vendor strategy and continuous improvement.
• Oversee pharmacy network adequacy and performance, ensuring alignment with strategic priorities such as network optimization, geo-access standards, and cost-efficiency. Ensure directory accuracy and ongoing compliance with applicable regulations.
• Lead efforts to mitigate vendor-related risks by conducting in-depth assessments. Ensure vendor compliance with all contractual, regulatory, and financial obligations.
• Present findings and recommendations to senior leadership, influencing decision-making and policy development related to PBM oversight and pharmacy strategy.
• Contribute to strategic initiatives across the organization as needed, ensuring the pharmacy benefits space is positioned for future growth and regulatory compliance.
• Other duties as assigned
  
  

Supervision Exercised

• No direct supervision exercised
  
  

Supervision Received

• General supervision received weekly
  
  

Qualifications

Education Required:

• Minimum of professional bachelor’s degree in health care administration, public health or related field, or an equivalent combination of education, training, and experience required.
  
  

Education Preferred

• Master’s degree
  
  

Experience Required

• Minimum of 3 years in managed care setting, either from provider, the payer, or the PBM side of the industry
  
  

Experience Preferred/Desirable

• Strong background in pharmacy benefits management, healthcare contract management, or pharmacy operations, with a proven ability to influence at the strategic level.
• Experience with managing complex vendor relationships, especially PBMs, with a track record of negotiating favorable contract terms and driving vendor accountability.
• In-depth understanding of Medicaid, Medicare, and commercial market regulations related to pharmacy benefits.
• Strong analytical skills with the ability to synthesize data and create strategic reports.
• Experience leading cross-functional teams and working with senior leadership.
• Proven ability to navigate regulatory landscapes and implement compliance strategies.
  
  

Required Licensure, Certification Or Conditions Of Employment

• Successful completion of pre-employment background check
  
  

Competencies, Skills, And Attributes

• Effective collaborative and proven process improvement skills.
• Strong oral and written communication skills; ability to interact within all levels of the organization.
• A strong working knowledge of Microsoft Office products.
• Demonstrated ability to successfully plan, organize and manage projects
• Detail oriented, excellent proof reading and editing skills.
  
  

Working Conditions And Physical Effort

• Regular and reliable attendance is an essential function of the position.
• Work is normally performed in a typical remote home office work environment.
• No or very limited physical effort required. No or very limited exposure to physical risk.
  
  

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees

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