AmeriHealth Caritas · 1 day ago
Vice President Pharmacy Actuarial
United States
Full-time
Remote
Director/Executive
15+ years expAmeriHealth Caritas is a mission-driven organization with over 30 years of experience in healthcare solutions. The Vice President, Pharmacy Actuarial leads the actuarial strategy and execution for pharmacy products and services, overseeing pricing, trend analysis, and forecasting while collaborating with various teams to ensure regulatory compliance and financial performance.
Health CareInformation Technology
Responsibilities
Lead actuarial strategy and oversight for all pharmacy-related functions across Medicare Part D, Medicaid, MMP/SNP, Exchange, and other product lines
Direct pharmacy pricing models, trend analytics, drug mix analyses, and total cost of care forecasting across all lines of business
Serve as strategic advisor to CFO, SVP of FP&A, Chief Actuary, Plan Presidents, and pharmacy leadership on PBM performance, rebate arrangements, pharmacy trend, and value-based drug strategies
Serve as strategic advisor to CFO, SVP of FP&A, Chief Actuary, Plan Presidents, and pharmacy leadership on PBM performance, rebate arrangements, pharmacy trend, and value-based drug strategies
Oversee CMS Part D bid development, including DIR assumptions, risk corridors, and PDE-based forecasting
Support financial modeling and pricing for pharmacy benefit inputs to Medicaid and Commercial premium rate filings and value-based payment models
Lead and develop a high-performing team of actuaries and analysts across the pharmacy actuarial domain
Collaborate with PBM, clinical pharmacy, product, finance, and government affairs teams on formulary management, rebate projections, and regulatory strategy
Qualification
Required
Bachelor's Degree in Actuarial Science, Statistics, Mathematics or another quantitative or business related field
Master's Degree: Master's degree in healthcare economics, public health, or business administration
At least 15 years of progressively responsible actuarial experience, including pharmacy-focused work across Medicare, Medicaid, and/or Commercial plans, with 3 to 5 years in executive or senior leadership roles
Expertise in pharmacy data structures (NDC, AWP, MAC pricing), rebate and discount mechanics, and 340B programs
Familiarity with CMS regulations, PDE data, DIR reconciliation, and Part D settlement processes
Proven ability to synthesize financial, clinical, and market data to support enterprise strategy
Effective communicator with the ability to engage executive stakeholders and external partners
Proficient in actuarial tools and data platforms (Excel, SAS, SQL, R/Python preferred)
Preferred
Master's degree in healthcare economics, public health, or business administration preferred
Experience with Medicare Part D and state Medicaid pharmacy rate setting strongly preferred
Background working directly with PBMs or in a PBM-integrated environment highly valued
Benefits
Flexible work solutions including remote options
Hybrid work schedules
Competitive pay
Paid time off including holidays and volunteer events
Health insurance coverage for you and your dependents on Day 1
401(k)
Tuition reimbursement
And more.
Company
AmeriHealth Caritas
AmeriHealth Caritas is the health care solutions provider for those in most need and the chronically ill.
10001+ employees
H1B Sponsorship
AmeriHealth Caritas has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (18)
2024 (17)
2023 (12)
2022 (14)
2021 (4)
2020 (11)
Funding
Current Stage
Late StageLeadership Team
Kathleen Giblin
SVP Clinical Operations
Ash Hanson
Executive Vice President & Chief Human Resources Officer
Recent News
2025-11-06
The Philadelphia Inquirer
2025-10-02
2025-10-01
Company data provided by crunchbase