Director, PBM Network Pricing & Market Strategy (Remote)

Navitus; City of Albany (NY); Remote; USD 150,000 - 210,000; Full time

Benefits offered by this job

Health insurance

401K with company match

Paid time off

Parental leave

9 holidays

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan

Referral Bonus Program

Job summary

Navitus Health Solutions is seeking an experienced Director of Network Pricing & Market Planning to own pharmacy network financial performance across all lines of business. The role focuses on contracting guarantees, BER/GER performance, and MAC outcomes, leading reconciliation and MAC pricing teams to drive measurable financial results.

Collaborate with Network Contracting, Underwriting, Finance, and Analytics to align terms with financial outcomes; role emphasizes post-contract performance

Qualifications

• Bachelor’s degree in Business, Finance, Economics, or Healthcare Administration, or equivalent work experience.
• 7+ years PBM/healthcare plan or related experience.
• 3+ years of leadership 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.
• Participate in, adhere to, and support compliance program objectives.

Responsibilities

• Lead the Network Reconciliation function with 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; drive corrective actions with 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).
• Lead MAC Pricing team with accountability for development, maintenance, and performance of enterprise MAC pricing.

Skills

Leadership

Pricing strategy

Market analysis

Network planning

RFP pricing

Compliance

Team collaboration

Education

Bachelor's degree in Business/Finance/Economics/Healthcare Administration

Job description

Navitus Health Solutions is seeking an experienced Director of Network Pricing & Market Planning to own pharmacy network financial performance across all lines of business. The role focuses on contracting guarantees, BER/GER performance, and MAC outcomes, leading reconciliation and MAC pricing teams to drive measurable financial results.

Collaborate with Network Contracting, Underwriting, Finance, and Analytics to align terms with financial outcomes; role emphasizes post-contract performance