Remote Director, Network Pricing & Market Planning

Navitus; Montpelier (VT); Remote; USD 150,000 - 210,000; Full time

Benefits offered by this job

Health insurance

PTO 20 days

Parental leave 4 weeks

Holidays 9 days

401K match up to 5%

Adoption assistance

Flexible Spending Account

Educational assistance

Referral bonus up to $750

Job summary

Navitus Health Solutions seeks an experienced Director of Network Pricing & Market Planning to own pharmacy network financial performance across all lines of business. You will lead reconciliation and MAC pricing teams to translate complex pricing structures into measurable financial outcomes, ensuring contract terms drive realized results.

You will partner with Contracting, Underwriting, Finance, and Analytics to align terms with outcomes, focusing on post-contract performance realization,

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 (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 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), 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

Leadership

Pricing strategy

Market analysis

Network planning

RFP pricing

Compliance awareness

Team development

Education

Bachelor’s degree in Business/Finance/Economics/Healthcare Admin

Job description

Navitus Health Solutions seeks an experienced Director of Network Pricing & Market Planning to own pharmacy network financial performance across all lines of business. You will lead reconciliation and MAC pricing teams to translate complex pricing structures into measurable financial outcomes, ensuring contract terms drive realized results.

You will partner with Contracting, Underwriting, Finance, and Analytics to align terms with outcomes, focusing on post-contract performance realization,