Director, PBM Network Pricing & Market Strategy

Navitus; Helena (MT); Remote; USD 170,000 - 260,000; Full time

Benefits offered by this job

Health insurance

Paid time off (PTO)

Parental leave

Paid holidays

401K company match

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan

Professional Membership assistance

Referral Bonus Program

Job summary

Navitus Health Solutions seeks a Director, Network Pricing & Market Planning with deep PBM expertise to own network pricing and reimbursement performance across all lines of business. You will lead the Network Reconciliation and MAC Pricing teams, translating pricing strategies into measurable financial outcomes and ensuring governance and post-contract performance realization.

The role partners with Network Contracting, Underwriting, Finance, and Analytics to align contracted terms with

Qualifications

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

Responsibilities

• Lead the Network Reconciliation function with accountability for validating performance against contracted rates and guarantees.
• Own reconciliation outcomes across all lines of business, ensuring accurate financial settlements.
• Establish processes to monitor, measure, and report network performance versus targets.
• Ensure audit readiness, financial transparency, and governance across reconciliation activities.
• Provide oversight of pricing constructs (effective rate, MAC, NADAC, PAC, AWP) and align outcomes with contracting intent.

Skills

PBM leadership

Pricing strategy

Network pricing

Reimbursement analytics

MAC pricing

Governance

Contracting

Education

Bachelor's degree in Business/Finance/ economics/ Healthcare Admin

Job description

Navitus Health Solutions seeks a Director, Network Pricing & Market Planning with deep PBM expertise to own network pricing and reimbursement performance across all lines of business. You will lead the Network Reconciliation and MAC Pricing teams, translating pricing strategies into measurable financial outcomes and ensuring governance and post-contract performance realization.

The role partners with Network Contracting, Underwriting, Finance, and Analytics to align contracted terms with