Director, PBM Network Pricing & Market Planning

Navitus Health Solutions, LLC

United States

Remote

USD 142,000 - 178,000

Full time

14 days+

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Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

PTO 20 days

Parental leave

Holidays 9

401K match

Adoption assistance

FSA

Education assistance

Referral bonus

Job summary

Navitus Health Solutions, LLC is seeking an experienced leader for Network Pricing & Market Planning to own pharmacy network financial performance across all lines of business. The role focuses on achieving contracted reimbursement guarantees, MAC pricing outcomes, and effective rate performance.

Responsibilities include leading reconciliation, governance, and post-contract performance realization, with collaboration across Contracting, Underwriting, Finance, and Analytics teams.

Qualifications

Bachelor’s degree in Business, Finance, Economics, or Healthcare Administration, or related field, or equivalent work experience.
7+ years of progressive PBM, healthcare plan, pharmacy network, or related experience.
3+ years of leadership experience delivering results in a professional services environment.
Pricing strategy, market analysis, or network planning experience.
Experience supporting RFP pricing and competitive market analysis.
Prior matrix-management experience preferred.
Participate in, adhere to, and support compliance program objectives.
Ability to interact cooperatively and respectfully with other employees.

Responsibilities

Lead the Network Reconciliation function with accountability for validating network performance against contracted effective rates 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; identify variances and drive corrective actions.
Insure audit readiness, financial transparency, and governance across all reconciliation activities.
Provide oversight of pricing constructs (e.g., MAC, NADAC, PAC, AWP) ensuring outcomes align with reimbursement intent.

Skills

Pricing strategy

Market analysis

Network planning

Leadership

RFP pricing

Compliance

Education

Bachelor degree (Business/Finance/Healthcare)

Job description

Company

Navitus

About Us

Navitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other. Current associates must use SSO login option at https://employees-navitus.icims.com/ to be considered for internal opportunities. We are committed to providing equal employment opportunity to all applicants and employees and comply with all applicable nondiscrimination regulations, including those related to protected veterans and individuals with disabilities. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or handicap.

Pay Range

USD $142,128.00 - USD $177,660.00 /Yr.

STAR Bonus % (At Risk Maximum)

15.00 - Director, GM of GP, PIC

Work Schedule Description (e.g. M-F 8am to 5pm)

M-F 8am-5pm

Remote Work Notification

ATTENTION: Navitus is unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.

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. 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? Find out more below!

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

Whatourteamexpectsfrom 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 fromNavitus?