Remote Director, PBM Network Pricing & Market Strategy

Navitus; Raleigh (NC); Remote; USD 140,000 - 190,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Paid time off - 20 days

Parental leave - 4 weeks

Holidays - 9 days

401K match up to 5%

Job summary

Navitus Health Solutions is seeking an experienced leader in Pharmacy Benefit Management to own network pricing and market planning across all lines of business. You will drive reconciliation, performance measurement, and pricing governance to achieve contracted reimbursement guarantees and MAC pricing outcomes.

The role partners with Contracting, Underwriting, Finance, and Analytics to align terms with financial results.

Qualifications

• Bachelor’s degree or equivalent work experience.
• 7+ years of progressive PBM/healthcare plan or network pricing experience.
• 3+ years of leadership experience delivering results.

Responsibilities

• Lead Network Reconciliation function and validate performance vs contracted rates.
• Own reconciliation outcomes across all lines of business and ensure accurate settlements.
• Monitor, measure, and report network performance against targets (BER/GER,MAC, NADAC, PAC).
• Oversee MAC Pricing strategy, governance, and adjustments to address market changes.
• Ensure audit readiness, governance, and pricing compliance across pricing constructs.

Skills

Pricing strategy

Market analysis

Network planning

Leadership

Education

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

7+ years of PBM/healthcare experience

3+ years of leadership experience

Job description

Navitus Health Solutions is seeking an experienced leader in Pharmacy Benefit Management to own network pricing and market planning across all lines of business. You will drive reconciliation, performance measurement, and pricing governance to achieve contracted reimbursement guarantees and MAC pricing outcomes.

The role partners with Contracting, Underwriting, Finance, and Analytics to align terms with financial results.