Director, PBM Network Pricing – Market Planning

🔥 18 minutes ago

🇺🇸 United States – Remote

💵 $142.1k - $177.7k / year

⏰ Full Time

🔴 Lead

👔 Director

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Navitus Health Solutions

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2003

💼 Consulting

🛡️ Insurance

🏥 Healthcare

Consulting • Insurance • Healthcare

Navitus Health Solutions is a pharmacy benefit manager (PBM) that provides transparent, people-centered pharmacy benefit solutions to health plans, employers, government programs and other plan sponsors. The company operates a 100% pass-through, cost-plus model that emphasizes lowering medication costs, managing formularies, specialty drug management (including a cost-plus specialty pharmacy), claims adjudication, pharmacy network management, and member enablement and support services. Navitus positions itself as a fiduciary partner focused on affordability, compliance, clinical quality and improving health outcomes through tailored PBM services and digital health integrations.

📋 Description

• 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

• 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

• 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%