Full-Time

Head of Pharmacy Strategy & Partnerships

Posted on 8/1/2025

ParetoHealth

ParetoHealth

201-500 employees

Self-insured employee health benefits captive program

No salary listed

No H1B Sponsorship

Remote in USA

Remote

Candidates must be authorized to work in the United States without sponsorship.

Category
Medical, Clinical & Veterinary (1)
Required Skills
Data Analysis
Requirements
  • 10+ years in PBM and/or TPA partnership management, preferably within self‑insurance, consultancy, or managed care environments.
  • Deep understanding of PBM contracting (rebates, guarantees, carve‑outs) and TPA plan administration, including stop loss carrier and consultant landscapes.
  • Proven ability to define, document, and scale complex workflows and processes; strong detail‑orientation.
  • Executive‑level presence with a demonstrated track record of cultivating and growing partnerships; relationship‑driven and initiative‑oriented.
  • Comfort working with data to drive decisions—experience with invoice reconciliation, KPI scorecards, and performance monitoring.
  • Outstanding written and verbal communication; adept at influencing senior stakeholders.
  • Thrives in fast‑paced environments, managing multiple priorities with urgency and ownership.
  • Willingness to travel up to 25%, including to Pareto HQ in Philadelphia and client sites.
  • Bachelor’s degree in Business, Finance, Pharmacy, Health Administration, or related field.
Responsibilities
  • Identifying, vetting and negotiating with potential new PBM participants in PRxC.
  • Lead rate negotiations, performance guarantees, carve‑outs, and reimbursement methodologies across all PRxC and other Rx cost containment partnerships.
  • Own processes for invoice review, dispute resolution, and performance tracking to ensure contractual compliance and client satisfaction.
  • Design and roll out standardized workflows for pricing assessments, invoice issuance, client implementations, and annual renewals.
  • Enhance data‑sharing pipelines and analytics dashboards with PBM partners to drive transparency and actionable insights.
  • Research, pilot, and implement overlay solutions (e.g., specialty pharmacy carve‑outs, rebate maximizers) to further reduce pharmacy spend.
  • Streamline end‑to‑end experience from pricing request to ongoing account management in partnership with Client Services and Product teams.
Desired Qualifications
  • MBA, PharmD, or advanced degree preferred
  • Experience building or scaling consortium/multi‑vendor network models preferred
  • Familiarity with specialty pharmacy and emerging point‑solution vendors preferred
  • Proficiency with analytics tools (SQL, Tableau, Python) preferred

ParetoHealth helps small and mid-sized employers control health benefit costs using a self-insured captive model. Member companies pool funds to cover employees’ health claims instead of paying traditional premiums, sharing risk within a group. A data-driven cost management system monitors plan use and guides care toward high-quality, cost-efficient options. Revenue comes from membership fees and consulting services, and the goal is to provide affordable, sustainable, high-quality benefits for SMEs while advancing diversity, equity, and inclusion.

Company Size

201-500

Company Stage

Growth Equity (Venture Capital)

Total Funding

$522.1K

Headquarters

Philadelphia, Pennsylvania

Founded

2011

Simplify Jobs

Simplify's Take

What believers are saying

  • Maeve O'Meara's 20+ years healthcare leadership and Castlight scaling experience accelerates technology and market expansion.[1]
  • Warburg Pincus investment validates growth trajectory and funds infrastructure scaling to capture larger employer segments.[1]
  • Employer flight from traditional insurance to self-funding accelerates as healthcare inflation persists through 2026–2027.[1]

What critics are saying

  • UnitedHealth, Anthem, Aetna launching competing self-funded platforms directly replicate ParetoHealth's value proposition within 12–24 months.[2]
  • Severe health crisis or mass claims exceeding stop-loss thresholds destabilizes entire 4,000-employer pool and triggers member exodus.[2]
  • Regulatory reclassification of group captives as non-compliant eliminates tax and structural advantages overnight, destroying business model.[2]

What makes ParetoHealth unique

  • Largest captive manager with 4,000+ employers and $8.4B healthcare spend creates unmatched negotiating leverage.[3]
  • Three-layer risk architecture (employer, captive, stop-loss) with Risk Shield guarantees eliminates unpredictable cost escalation.[1]
  • Savings Engine integrates data analytics and clinical intervention to deliver 16.5% Year 3 savings versus cost-shifting.[1]

Help us improve and share your feedback! Did you find this helpful?

Your Connections

People at ParetoHealth who can refer or advise you

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Disability Insurance

401(k) Company Match

401(k) Retirement Plan

Company News

HIT Consultant
Feb 4th, 2025
Paretohealth Appoints Maeve O’Meara As Chief Executive Officer

ParetoHealth Appoints Maeve O’Meara as Chief Executive Officer. by Healthcare Executive Hires 02/04/2025 Leave a Comment. Maeve O’Meara, CEO at ParetoHealthWhat You Should Know: – ParetoHealth, a provider of innovative health benefits solutions for midsize employers, today announced the appointment of Maeve O’Meara as its new Chief Executive Officer.– O’Meara, who has served as ParetoHealth’s President since September 2023, succeeds co-founder Andrew Cavenagh, who will transition to the role of Executive Chairman. Maeve O’Meara Bio/BackgroundO’Meara brings over 20 years of experience in healthcare and technology leadership to her new role. She previously served as CEO of Castlight Health, where she spearheaded the company’s transformation into a market-leading navigation platform. Since joining ParetoHealth, O’Meara has focused on deepening consultant and member engagement, scaling technology and infrastructure, and strengthening the leadership team.“I’m honored to lead a team that has truly challenged the status quo in enabling midsize employers to offer more affordable health benefits,” said O’Meara. “It is a privilege to partner with our incredible consultant and employer community to continue to innovate and redefine what is possible.”

ParetoHealth
Jan 7th, 2025
ParetoHealth Appoints Heather Underhill as Chief Customer Officer to Advance Customer Success Initiatives

ParetoHealth appoints Heather Underhill as Chief Customer Officer to advance customer success initiatives.

The Daily Review
Jun 26th, 2024
ParetoHealth Appoints Christine Lui Chen as Chief Marketing Officer for Next Chapter of Growth

PHILADELPHIA, PA / ACCESSWIRE / June 26, 2024 / ParetoHealth, the nation's largest and fastest-growing employer-owned health benefits solution, is pleased to announce the appointment of Christine Lui Chen as Chief Marketing Officer.

PressRelease.com
Sep 27th, 2023
ParetoHealth Names Maeve O'Meara as President

PHILADELPHIA, September 27, 2023 (Newswire.com) - ParetoHealth, the country's leading health insurance platform for small and medium-sized employers, announced today that it has named Maeve O'Meara as President.

LexBlog
Jun 24th, 2023
Healthcare & Life Sciences Private Equity Deal Tracker: Warburg Pincus Invests in ParetoHealth

Warburg Pincus has invested in ParetoHealth, according to a news release.

INACTIVE