Remote Director, PBM Network Pricing & Market Strategy

Navitus; Denver (CO); Remote; USD 180,000 - 230,000; Full time

Benefits offered by this job

Health, Dental, Vision insurance

20 days paid time off

4 weeks paid parental leave

9 paid holidays

401K company match up to 5%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan and Pro/MV

Referral Bonus Program – up to $750

Job summary

Navitus Health Solutions seeks an experienced leader to own pharmacy network financial performance across all lines of business. The Director will ensure contracted reimbursement guarantees, manage MAC pricing, and drive reconciliation, governance, and pricing interventions to realize contractual outcomes.

The role partners with Network Contracting, Underwriting, Finance and Analytics to align terms with performance while executing 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 leading high-performing teams and delivering results.
• Pricing strategy, market analysis, or network planning experience.
• Experience supporting RFP pricing and competitive market analysis.
• Prior experience leading or matrix-management experience preferred.
• Participation in, adherence to, and support of compliance program objectives.
• Ability to interact cooperatively and respectfully with colleagues.

Responsibilities

• Lead Network Performance Ownership & Reconciliation 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 and enforce processes to monitor, measure, and report network performance vs. targets (e.g., AWP discounts, rate thresholds).
• 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 the MAC Pricing team to develop, maintain, and monitor enterprise MAC pricing.

Skills

Leadership

Pricing strategy

Pricing governance

Reimbursement analytics

Team management

RFP pricing

Compliance

Cross-functional collaboration

Education

Bachelor’s degree (Business/Finance/Economics/Healthcare Administration)

Job description

Navitus Health Solutions seeks an experienced leader to own pharmacy network financial performance across all lines of business. The Director will ensure contracted reimbursement guarantees, manage MAC pricing, and drive reconciliation, governance, and pricing interventions to realize contractual outcomes.

The role partners with Network Contracting, Underwriting, Finance and Analytics to align terms with performance while executing post-contract performance realization.