Director, Pharmacy Network Pricing & Market Planning

Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. Our team members work in an environment that celebrates diversity, fosters creativity, and encourages growth.

About the role

The Director, Network Pricing & Market Planning is responsible for owning pharmacy network financial performance across all lines of business, with direct accountability for achieving contracted reimbursement guarantees, including effective rate (BER/GER) performance and MAC pricing outcomes. This role leads the Network Reconciliation and MAC Pricing teams and ensures that contracted pharmacy rates are operationalized, monitored, and achieved. The Director focuses on performance execution—translating network pricing strategies into realized financial outcomes through rigorous reconciliation, variance management, and pricing intervention. This position partners with Network Contracting, Underwriting, Finance, and Analytics leadership to ensure alignment between contracted terms and financial outcomes. The role is accountable for post-contract performance realization, owning the processes, teams, and controls that ensure pharmacy reimbursement aligns with contractual expectations.

Responsibilities

• Lead the Network Reconciliation function with full accountability for validating pharmacy network performance against contracted effective rates (BER/GER) 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 on network performance vs. contractual targets (e.g., AWP discounts, effective rate thresholds).
• Identify performance variances and drive corrective actions in partnership with Network Contracting and Pricing teams.
• Ensure audit readiness, financial transparency, and governance across all reconciliation activities.
• Provide oversight of pharmacy network performance across all pricing constructs (e.g., effective rate, MAC, NADAC, PAC, flat AWP), ensuring reported outcomes align with contracted reimbursement intent.
• Lead the MAC Pricing team with accountability for development, maintenance, and performance of enterprise MAC pricing.
• Ensure MAC pricing effectively supports achievement of contracted effective rates and overall network financial targets.
• Oversee ongoing monitoring of claim-level reimbursement performance to identify outliers and pricing inefficiencies.
• Drive timely MAC adjustments to address performance gaps, market changes, and provider behavior.
• Establish governance and controls to ensure MAC pricing is competitive, compliant, and 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.
• The ability to consistently interact cooperatively and respectfully with other employees.

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!

Pay

USD $142,128.00 - USD $177,660.00 /Yr. with a STAR Bonus of up to 15.00% (At Risk Maximum).

Schedule

Monday to Friday, 8:00 AM to 5:00 PM.

Remote work is not available to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.