Director, Remote Network Pricing & MAC Strategy

Navitus; Washington (District of Columbia); Remote; USD 180,000 - 240,000; Full time

Benefits offered by this job

Health, Dental, Vision insurance

Paid time off

Parental leave

Paid holidays

401K company match

Adoption assistance

Flexible Spending Account

Educational assistance

Professional membership assistance

Referral bonus

Job summary

Navitus Health Solutions seeks an experienced leader to own pharmacy network pricing and market planning, translating complex pricing into measurable financial outcomes across all lines of business. The Director leads reconciliation and MAC pricing teams, ensuring contracted rates are realized, audited, and governed, with collaboration across contracting, underwriting, finance, and analytics leadership.

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Qualifications

• Bachelor’s degree in Business, Finance, Economics, or Healthcare Administration, or equivalent work experience.
• 7+ years of progressive PBM, healthcare plan, pharmacy network, or related experience.
• 3+ years of leadership experience with a proven ability to develop high-performing teams and deliver tangible results.
• Demonstrated experience in pricing strategy, market analysis, or network planning.
• Experience supporting RFP pricing and competitive market analysis.
• Prior leadership or 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 (e.g., AWP discounts, effective rate thresholds). Identify variances and drive corrective actions 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, even where pricing methodologies are managed outside of this function.
• 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

PBM expertise

Pricing strategy

Leadership

Reconciliation

MAC pricing

Contract terms understanding

Education

Bachelor’s degree or equivalent

Job description

Navitus Health Solutions seeks an experienced leader to own pharmacy network pricing and market planning, translating complex pricing into measurable financial outcomes across all lines of business. The Director leads reconciliation and MAC pricing teams, ensuring contracted rates are realized, audited, and governed, with collaboration across contracting, underwriting, finance, and analytics leadership.

Is this you?