Remote Director, PBM Network Pricing & Market Strategy

Navitus; Boise (ID); Remote; USD 180,000 - 260,000; Full time

Benefits offered by this job

Health insurance

Paid time off

Parental leave

Holidays

401K match

Adoption assistance

Flexible Spending Account

Educational assistance

Professional membership assistance

Referral bonus

Job summary

Navitus Health Solutions seeks an experienced Director, Network Pricing & Market Planning to own pharmacy network financial performance across all lines of business. You will ensure contracted reimbursement guarantees and MAC pricing outcomes are achieved, leading the Network Reconciliation and MAC Pricing teams to translate pricing strategies into real results.

The ideal candidate has 7+ years in PBM or healthcare pricing with strong leadership and governance experience.

Qualifications

• 7+ years of progressive PBM, healthcare plan, pharmacy network, or related experience.
• 3+ years of leadership experience delivering results in a professional services environment.
• 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.
• Ability to participate in and support compliance program objectives.
• Ability to interact cooperatively and respectfully with others.

Responsibilities

• Lead the Network Reconciliation function with accountability for validating network performance against contracted rates and pricing guarantees.
• Own reconciliation outcomes across all lines of business, ensuring accurate financial settlement and alignment to contract terms.
• Establish processes to monitor, measure, and report on network performance vs. targets (e.g., AWP discounts, effective rate thresholds).
• Identify variances and drive corrective actions with Contracting and Pricing teams.
• Ensure audit readiness, financial transparency, and governance across reconciliation activities.
• Provide oversight of network performance across pricing constructs (e.g., BER/GER, MAC, NADAC, PAC, AWP).
• Lead MAC Pricing team for development, maintenance, and performance of enterprise MAC pricing.
• Oversee ongoing monitoring of claim-level reimbursement performance to identify outliers and inefficiencies.
• Drive timely MAC adjustments to address performance gaps and market changes.
• Establish governance to keep MAC pricing competitive and compliant.

Skills

PBM expertise

Leadership

Pricing strategy

Market analysis

RFP pricing

Contracting terms

Compliance

Education

Bachelor’s degree in Business, Finance, Economics, or Healthcare Administration

Job description

Navitus Health Solutions seeks an experienced Director, Network Pricing & Market Planning to own pharmacy network financial performance across all lines of business. You will ensure contracted reimbursement guarantees and MAC pricing outcomes are achieved, leading the Network Reconciliation and MAC Pricing teams to translate pricing strategies into real results.

The ideal candidate has 7+ years in PBM or healthcare pricing with strong leadership and governance experience.