Director, PBM Network Pricing & Market Planning

Navitus; Lansing (MI); A distancia; USD 180.000 - 260.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Health insurance

Dental insurance

Vision insurance

20 days paid time off

4 weeks paid parental leave

9 paid holidays

401K company match up to 5%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan and Pro/M–

Referral Bonus Program - up to $750!

Descripción de la vacante

Navitus is seeking an experienced Director, Network Pricing & Market Planning to own pharmacy network financial performance across all lines of business. You will translate pricing strategies into measurable outcomes, oversee reconciliation, MAC pricing, and governance, and collaborate with contract, underwriting, finance, and analytics teams.

You will lead a team focused on effective rate performance, MAC adjustments, and pricing governance to ensure contracted reimbursement aligns with terms,

Formación

• Bachelor’s degree or equivalent work experience required.
• 7+ years of progressive PBM, healthcare plan, pharmacy network, or related experience.
• 3+ years of leadership experience delivering results in professional services.
• Experience in pricing strategy, market analysis, or network planning.
• Experience supporting RFP pricing and competitive market analysis.

Responsabilidades

• Lead the Network Reconciliation function with accountability for validating network performance against contracted rates and pricing guarantees.
• Own reconciliation outcomes across all lines of business, ensuring accurate financial settlement.
• Monitor, measure, and report on network performance vs. targets and drive corrective actions.
• Provide governance and controls for MAC pricing, effective rate, NADAC, PAC, and other constructs.
• Oversee MAC pricing strategy execution and ongoing performance monitoring.

Conocimientos

Leadership

Pricing strategy

Market analysis

RFP pricing

Matrix management

Compliance

Team development

Educación

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

Descripción del empleo

Overview

Due to continued growth, we are adding an experienced leader with deep Pharmacy Benefit Management (PBM) expertise and a strong background in pharmacy reimbursement, network pricing, and Maximum Allowable Cost (MAC) pricing strategies to our growing team. The ideal candidate brings a proven track record of translating complex pharmacy pricing and contracting structures into measurable financial performance, with experience overseeing effective rate guarantees, reimbursement analytics, and pricing governance. This role is critical to ensuring that network pricing strategies are operationalized effectively and deliver expected outcomes across all lines of business.

The Director, Network Pricing & Market Planning is responsible for owning pharmacy network financial performance across all lines of business, with direct accountability for achieving contracted reimbursement guarantees, including effective rate (BER/GER) performance and MAC pricing outcomes.

The Director, Network Pricing & Market Planning is responsible for owning pharmacy network financial performance across all lines of business, with direct accountability for achieving contracted reimbursement guarantees, including effective rate (BER/GER) performance and MAC pricing outcomes. This role leads the Network Reconciliation and MAC Pricing teams and is accountable for ensuring that contracted pharmacy rates are operationalized, monitored, and achieved. The Director focuses on performance execution-translating network pricing strategies into realized financial outcomes through rigorous reconciliation, variance management, and pricing intervention.

The Director partners with Network Contracting, Underwriting, Finance, and Analytics leadership to ensure alignment between contracted terms and financial outcomes. Unlike strategy or informatics roles, this position is accountable for post-contract performance realization-owning the processes, teams, and controls that ensure pharmacy reimbursement aligns with contractual expectations. This includes reconciliation oversight, effective rate compliance, MAC performance, and corrective action when performance deviates.

Is this you?

Responsibilities

How do I make an impact on my team?

Network Performance Ownership & Reconciliation Leadership

• Lead the Network Reconciliation function with full accountability for validating pharmacy network performance against contracted effective rates (BER/GER) and pricing guarantees.
• Own reconciliation outcomes across all lines of business, ensuring accurate financial settlement and alignment to contract terms.
• Establish and enforce processes to monitor, measure, and report on network performance vs. contractual targets (e.g., AWP discounts, effective rate thresholds).
  Identify performance variances and drive corrective actions in partnership with Network Contracting and Pricing teams.
• Insure audit readiness, financial transparency, and governance across all reconciliation activities.
• Provide oversight of pharmacy network performance across all pricing constructs (e.g., effective rate, MAC, NADAC, PAC, flat AWP), ensuring reported outcomes align with contracted reimbursement intent, even where pricing methodologies are managed outside of this function.

MAC Pricing Strategy Execution & Governance

• Lead the MAC Pricing team with accountability for development, maintenance, and performance of enterprise MAC pricing.
• Ensure MAC pricing effectively supports achievement of contracted effective rates and overall network financial targets.
• Oversee ongoing monitoring of claim-level reimbursement performance to identify outliers and pricing inefficiencies.
• Drive timely MAC adjustments to address performance gaps, market changes, and provider behavior.
• Establish governance and controls to ensure MAC pricing is competitive, compliant, and aligned with enterprise financial goals.

Qualifications

What our team expects from you?

• Bachelor’s degree in Business, Finance, Economics, or Healthcare Administration, or related field, or equivalent work experience, required.
• 7+ years of progressive PBM, healthcare plan, pharmacy network, or related experience required.
• 3+ years of leadership experience with a proven ability to develop high-performing teams and deliver tangible results in a professional services environment required.
• Demonstrated experience in pricing strategy, market analysis, or network planning required.
• Experience supporting RFP pricing and competitive market analysis required.
• Prior experience leading or matrix-management experience preferred.
• Participate in, adhere to, and support compliance program objectives.
• The ability to consistently interact cooperatively and respectfully with other employees.

What can you expect from Navitus?

• Top of the industry benefits for Health, Dental, and Vision insurance
• 20 days paid time off
• 4 weeks paid parental leave
• 9 paid holidays
• 401K company match of up to 5% - No vesting requirement
• Adoption Assistance Program
• Flexible Spending Account
• Educational Assistance Plan and Professional Membership assistance
• Referral Bonus Program - up to $750!

#LI-Remote

Navitus Health Solutions is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, creed, sex, pregnancy, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, veteran status, or any other characteristic protected by law.

Equal employment opportunity, including veterans and individuals with disabilities.