Director, PBM Network Pricing & Market Strategy

Navitus; Carson City (NV); Remote; USD 150,000 - 210,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Paid time off

Parental leave

401k match

Education assistance

Referral bonus

Job summary

Navitus Health Solutions seeks an experienced Director of Network Pricing & Market Planning to drive network financial performance, oversee reimbursement guarantees, and lead MAC pricing initiatives. The role partners with Contracting, Underwriting, Finance, and Analytics to translate contracts into outcomes, focusing on post-contract performance and governance across all lines of business.

This remote-friendly leadership role offers comprehensive benefits and opportunities to influence pricing

Qualifications

• Bachelor’s degree in Business, Finance, Economics, 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 building high-performing teams in a professional services environment.
• Demonstrated experience in pricing strategy, market analysis, or network planning.
• Experience supporting RFP pricing and competitive market analysis.
• Prior matrix-management experience preferred.
• Participate in, adhere to, and support compliance program objectives.
• The ability to consistently interact cooperatively and respectfully with other employees.

Responsibilities

• 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.

Skills

Pricing strategy

Market analysis

Network planning

Leadership

Compliance

Team collaboration

Education

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

Job description

Navitus Health Solutions seeks an experienced Director of Network Pricing & Market Planning to drive network financial performance, oversee reimbursement guarantees, and lead MAC pricing initiatives. The role partners with Contracting, Underwriting, Finance, and Analytics to translate contracts into outcomes, focusing on post-contract performance and governance across all lines of business.

This remote-friendly leadership role offers comprehensive benefits and opportunities to influence pricing