Director, PBM Network Pricing & Market Planning (Remote)

Navitus; Hartford (CT); Remoto; USD 170.000 - 230.000; Tempo pieno

Vantaggi offerti da questo lavoro

Health, Dental, Vision insurance

Paid Time Off 20 days

Parental leave 4 weeks

9 paid holidays

401K company match

Adoption assistance

Flexible Spending Account

Educational assistance & professional

Referral bonus

Descrizione del lavoro

Navitus Health Solutions, Hartford, CT, seeks an experienced Director of Network Pricing & Market Planning to lead network reconciliation and MAC pricing initiatives. You will drive performance against contracted rates, oversee price governance across multiple constructs, and translate pricing strategies into measurable financial results.

With 7+ years in PBM or healthcare pricing, you will partner with contracting, underwriting, finance, and analytics to realize post-contract value while

Competenze

• Bachelor’s degree required 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 required.
• 3+ years of leadership experience with 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.

Mansioni

• 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.
• 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.

Conoscenze

Leadership

Pricing strategy

Market analysis

RFP pricing

Compliance

Formazione

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

Descrizione del lavoro

Navitus Health Solutions, Hartford, CT, seeks an experienced Director of Network Pricing & Market Planning to lead network reconciliation and MAC pricing initiatives. You will drive performance against contracted rates, oversee price governance across multiple constructs, and translate pricing strategies into measurable financial results.

With 7+ years in PBM or healthcare pricing, you will partner with contracting, underwriting, finance, and analytics to realize post-contract value while