Director, PBM Network Pricing & Market Strategy (Remote)

Navitus Health Solutions / Lumicera Health Services; United States; Remote; USD 142,000 - 178,000; Full time

Benefits offered by this job

Health insurance

401K with company match

Paid time off

Parental leave

Education Assistance

Referral bonus

Job summary

Navitus is seeking an experienced Director, Network Pricing & Market Planning to own pharmacy network financial performance across all lines of business. This leader will ensure contracted reimbursement guarantees, including effective rate and MAC pricing outcomes, are operationalized and achieved.

You will oversee reconciliation and MAC pricing teams, driving governance, analytics, and pricing intervention to translate strategies into realized financial results.

Qualifications

• Bachelor’s degree in Business, Finance, Economics, or Healthcare Administration, or related field, or equivalent work experience, required.
• 7+ years of progressive PBM, healthcare plan, pharmacy network, or related experience required.
• 3+ years of leadership experience with a 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.

Responsibilities

• Lead the Network Reconciliation function with full accountability for validating pharmacy network performance against contracted effective rates 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).
• 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.

Skills

Leadership

Pricing strategy

PBM experience

Team development

Communication

Education

Bachelor’s degree in BusinessFinanceEconomicsHealthcare Administration

Job description

Navitus is seeking an experienced Director, Network Pricing & Market Planning to own pharmacy network financial performance across all lines of business. This leader will ensure contracted reimbursement guarantees, including effective rate and MAC pricing outcomes, are operationalized and achieved.

You will oversee reconciliation and MAC pricing teams, driving governance, analytics, and pricing intervention to translate strategies into realized financial results.