Director, PBM Network Pricing & Market Optimization

Navitus; Springfield (IL); Vor Ort; USD 180.000 - 230.000; Vollzeit

Benefits dieser Stelle

Health insurance

Dental insurance

Vision insurance

Paid time off

Parental leave

Holiday pay

401K match

Adoption Assistance

FSAs

Education assistance

Professional memberships

Referral bonus

Zusammenfassung

Navitus Health Solutions seeks an experienced Director, Network Pricing & Market Planning to own pharmacy network financial performance across lines of business. You will ensure contracted reimbursement guarantees, manage MAC pricing outcomes, and translate pricing strategies into tangible financial results.

You will lead the Network Reconciliation and MAC Pricing teams, monitor performance, and partner with Contracting, Underwriting, Finance, and Analytics to align terms with outcomes.

Qualifikationen

• Bachelor's degree or equivalent work experience in a related field is required.
• 7+ years of progressive PBM, healthcare plan, pharmacy network, or related experience.
• 3+ years of leadership experience developing and delivering results in professional services.
• Demonstrated experience in pricing strategy, market analysis, or network planning.
• Experience supporting RFP pricing and competitive market analysis.
• Prior matrix-management experience is preferred.
• Participation in compliance programs and ability to work cooperatively with others.

Aufgaben

• Lead Network Reconciliation with accountability for validating performance vs contracted rates and guarantees.
• Own outcomes across all lines of business with accurate financial settlement to contracts.
• Monitor, measure, and report network performance against targets; drive corrective actions with Pricing teams.
• Oversee MAC Pricing strategy development, governance, and ongoing adjustments.
• Ensure governance that MAC pricing is competitive, compliant, and aligned with financial goals.

Kenntnisse

PBM pricing

Network pricing

Pricing governance

Leadership

Reimbursement analytics

Contract terms understanding

Cross-functional collaboration

Ausbildung

Bachelor's degree in Business, Finance, Economics, or Healthcare Administration

Jobbeschreibung

Navitus Health Solutions seeks an experienced Director, Network Pricing & Market Planning to own pharmacy network financial performance across lines of business. You will ensure contracted reimbursement guarantees, manage MAC pricing outcomes, and translate pricing strategies into tangible financial results.

You will lead the Network Reconciliation and MAC Pricing teams, monitor performance, and partner with Contracting, Underwriting, Finance, and Analytics to align terms with outcomes.