Director, PBM Network Pricing & Market Strategy

Navitus; Nashville (TN); On-site; USD 180,000 - 240,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Paid time off

Parental leave

401K match

Adoption assistance

Flexible Spending Account

Educational assistance

Referral bonus

Job summary

Navitus Health Solutions seeks an experienced leader to own pharmacy network financial performance across all lines of business, with accountability for GER/BER results and MAC pricing outcomes. This role leads Network Reconciliation and MAC Pricing teams, ensuring contracted rates are operationalized and achieved.

The Director partners with Contracting, Underwriting, Finance, and Analytics to align terms with outcomes, focusing on post-contract performance realization and governance across

Qualifications

• Bachelor’s degree or equivalent experience required.
• 7+ years of PBM/healthcare network experience required.
• 3+ years of leadership experience required.
• Demonstrated pricing strategy, market analysis, or network planning experience required.
• Experience supporting RFP pricing and market analysis required.
• Leadership or matrix-management experience preferred.
• Compliance program participation expected.
• Must interact cooperatively with others.

Responsibilities

• Lead Network Reconciliation to validate performance against contracted rates and pricing guarantees.
• Own reconciliation outcomes across all lines of business with accurate financial settlement.
• Establish processes to monitor, measure, and report network performance vs. targets; drive corrective actions.
• Ensure audit readiness, transparency, and governance across reconciliation activities.
• Oversee MAC Pricing governance and enterprise MAC pricing performance.
• Lead MAC Pricing team to maintain pricing strategies and outcomes.
• Monitor claim-level reimbursement to identify outliers and pricing inefficiencies.
• Drive timely MAC adjustments in response to market changes and provider behavior.
• Establish controls to keep MAC pricing competitive and aligned with financial goals.

Skills

PBM expertise

Pricing strategy

Leadership

Reimbursement analytics

Network planning

Education

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

Job description

Navitus Health Solutions seeks an experienced leader to own pharmacy network financial performance across all lines of business, with accountability for GER/BER results and MAC pricing outcomes. This role leads Network Reconciliation and MAC Pricing teams, ensuring contracted rates are operationalized and achieved.

The Director partners with Contracting, Underwriting, Finance, and Analytics to align terms with outcomes, focusing on post-contract performance realization and governance across