Remote Director, PBM Network Pricing & MAC Strategy

Navitus; Baton Rouge (LA); Remoto; USD 180.000 - 260.000; Tempo pieno

Vantaggi offerti da questo lavoro

Health insurance

PTO 20 days

Parental leave

Paid holidays

401K match

Adoption assistance

FSA

Education assistance

Referral bonus

Descrizione del lavoro

Navitus Health Solutions is seeking an experienced Director, Network Pricing & Market Planning to lead cross-functional efforts ensuring pharmacy network financial performance across all lines of business. You will own reimbursement guarantees, MAC pricing outcomes, and governance, partnering with Contracting, Underwriting, Finance, and Analytics to translate pricing strategies into measurable results.

The role requires 7+ years in PBM or healthcare pricing, with at least 3 years of leadership

Competenze

• Bachelor’s degree 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.
• 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.

Mansioni

• 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.

Conoscenze

Leadership

Pricing strategy

Market analysis

Network planning

RFP pricing

Team development

Compliance

Collaboration

Formazione

Bachelor’s degree in Business, Finance, Economics, or Healthcare Administration, or related field, or equivalent work experience

Descrizione del lavoro

Navitus Health Solutions is seeking an experienced Director, Network Pricing & Market Planning to lead cross-functional efforts ensuring pharmacy network financial performance across all lines of business. You will own reimbursement guarantees, MAC pricing outcomes, and governance, partnering with Contracting, Underwriting, Finance, and Analytics to translate pricing strategies into measurable results.

The role requires 7+ years in PBM or healthcare pricing, with at least 3 years of leadership