Director, PBM Network Pricing – Market Planning

Navitus Health Solutions

. Own pharmacy network financial performance across all lines of business.

Posted 9/18/2026full-timeRemote • United StatesLead💰 $142,128 - $177,660 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in pharmacy network financial performance, including effective rate management, MAC pricing strategies, and compliance with contractual obligations. Proven leadership in developing high-performing teams and driving corrective actions to enhance network performance.

Highest-signal resume keywords

Pharmacy Network Financial PerformanceMAC Pricing StrategyLeadership ExperiencePricing Strategy DevelopmentMarket Analysis

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Effective Rate ManagementMAC PricingNADAC PricingPAC PricingAWP PricingReimbursement Performance MonitoringNetwork ReconciliationContract ComplianceFinancial SettlementPerformance Variance Analysis

Soft Skills

Team DevelopmentInterpersonal CommunicationCooperative InteractionProblem SolvingLeadership

Industry Keywords

Pharmacy Benefit ManagementHealthcare PlanContractual TargetsRFP PricingProfessional Services Environment

About the role

Key responsibilities & impact

Own pharmacy network financial performance across all lines of business.
Achieve contracted reimbursement guarantees, including effective rate (BER/GER) performance and MAC pricing outcomes.
Lead the Network Reconciliation and MAC Pricing teams.
Validate pharmacy network performance against contracted effective rates and pricing guarantees.
Own reconciliation outcomes, financial settlement, and alignment to contract terms.
Establish and enforce processes to monitor, measure, and report network performance against contractual targets.
Identify performance variances and drive corrective actions with Network Contracting and Pricing teams.
Ensure audit readiness, financial transparency, and governance across reconciliation activities.
Oversee pharmacy network performance across effective rate, MAC, NADAC, PAC, and flat AWP pricing constructs.
Lead development, maintenance, and performance of enterprise MAC pricing.
Monitor claim-level reimbursement performance for outliers and pricing inefficiencies.
Drive MAC adjustments for performance gaps, market changes, and provider behavior.
Partner with Network Contracting, Underwriting, Finance, and Analytics leadership.

Requirements

What you’ll need

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.
Remote work is unavailable to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.

Benefits

Comp & perks

Top of the industry benefits for Health, Dental, and Vision insurance
20 days paid time off
4 weeks paid parental leave
9 paid holidays
401K company match of up to 5% - No vesting requirement
Adoption Assistance Program
Flexible Spending Account
Educational Assistance Plan and Professional Membership assistance
Referral Bonus Program – up to $750%