Director, Pharmacy Network Pricing – Market Planning

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $142.1k - $177.7k / year

⏰ Full Time

🔴 Lead

💊 Pharmacist

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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 • Ensure contracted pharmacy rates are operationalized, monitored, and achieved • Translate network pricing strategies into realized financial outcomes through reconciliation, variance management, and pricing intervention • Partner with Network Contracting, Underwriting, Finance, and Analytics leadership • Validate pharmacy network performance against contracted effective rates and pricing guarantees • Own reconciliation outcomes and ensure accurate financial settlement aligned with contract terms • Establish processes to monitor, measure, and report network performance against contractual targets • Identify performance variances and drive corrective actions • Ensure audit readiness, financial transparency, and governance • 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 timely MAC adjustments for performance gaps, market changes, and provider behavior • Establish governance and controls for competitive, compliant MAC pricing aligned with enterprise financial goals

🎯 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 • Ability to consistently interact cooperatively and respectfully with other employees • Remote work 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! • STAR Bonus: 15.00% at-risk maximum